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According to the ''APA Dictionary of Psychology'', alcoholism is the popular term for ''alcohol dependence''.<ref name = "APA"/> Note that there is debate whether ''dependence'' in this use is physical (characterised by withdrawal), psychological (based on [[reinforcement]]), or both.
=== Terminology ===
{{Unreferencedsection|date=November 2007}}
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'''''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 fellowship known as [[Alcoholics Anonymous]] does not use the term "remission" because AA's basic text, which was first published in 1939, uses the terms "recover" and "recovered" to describe those who have stopped consuming alcohol by addressing their underlying problem. On page 64, the AA text says "Our liquor was but a symptom. So we had to get down to causes and conditions."<ref name="AABigBook">{{cite book | last = Anonymous | first = | authorlink = Alcoholics Anonymous | coauthors = The first 100 members of AA | title = Alcoholics Anonymous: the story of how many thousands of men and women have recovered from alcoholism | publisher = Alcoholics Anonymous World Services | date = 1939, 2001 | location = New York City | pages = xxxii, 575 p. | url = www.aa.org | doi = | id = | isbn = 1893007162 | nopp = true }}</ref>
== Etymology ==
[[Imageकिपा:1904 Claim of Alcoholism being Disease.jpg|thumb|1904 advertisement labeling alcoholism a disease.]]The term "alcoholism" was first used in 1849 by the physician Magnus Huss to describe the systematic adverse effects of alcohol.<ref>{{citeweb|title=Alcoholismus chronicus, eller Chronisk alkoholssjukdom:|url=http://books.google.com/books?hl=en&lr=&id=wt6r2Zw8sCEC&oi=fnd&pg=PR5&ots=TTCBeEzjQ2&sig=jxuMZ5wgL48SZjvu1PcwXIdjFJw#PPP1,M1|publisher=Stockholm und Leipzig|accessdate=2008-02-19}}</ref>
In the [[United States]], use of the word "alcoholism" was{{Fact|date=October 2008}} largely popularized by the founding and growth of [[Alcoholics Anonymous]] in 1935. AA's basic text, known as the "Big Book," describes alcoholism as an illness that involves a physical allergy<ref name="AABigBook"/>{{rp|p.xxviii}} and a mental obsession.<ref name="AABigBook"/>{{rp|p.23}}<ref>{{citeweb|title=The Big Book Self Test:|url=http://www.intoaction.us/SelfTest.html|publisher=intoaction.us|accessdate=2008-02-19}}</ref> Note that the definition of "allergy" used in this context is not the same as used in modern medicine.<ref>{{cite journal |author=Kay AB |title=Overview of 'allergy and allergic diseases: with a view to the future' |journal=Br. Med. Bull. |volume=56 |issue=4 |pages=843–64 |year=2000 |pmid=11359624| doi = 10.1258/0007142001903481 <!--Retrieved from CrossRef by DOI bot-->}}</ref>
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A minority opinion within the field, notably advocated by Herbert Fingarette and [[Stanton Peele]], argue against the existence of alcoholism as a disease. Critics of the disease model tend to use the term "heavy drinking" when discussing the negative effects of alcohol consumption.
== Epidemiology ==
[[Imageकिपा:Alcohol consumption per capita world map.PNG|thumb|200px|Total recorded yearly [[countries by alcohol consumption|alcohol per capita consumption]] (15+), in litres of pure alcohol<ref>[http://www.who.int/entity/substance_abuse/publications/global_status_report_2004_overview.pdf Global Status Report on Alcohol 2004]</ref>]]
Substance use disorders are a major [[public health]] problem facing many countries. "The most common substance of abuse/dependence in patients presenting for treatment is alcohol."<ref name=Gabbard>Gabbard: "Treatments of Psychiatric Disorders". Published by the American Psychiatric Association: 3rd edition, 2001, ISBN 0-88048-910-3</ref> In the [[United Kingdom]], the number of 'dependent drinkers' was calculated as over 2.8 million in 2001.<ref name=cosu>Cabinet Office Strategy Unit [http://www.strategy.gov.uk/downloads/files/econ.pdf Alcohol misuse: How much does it cost?] September 2003</ref> The [[World Health Organization]] estimates that about 140 million people throughout the world suffer from alcohol dependence.<ref>[http://www.who.int/director-general/speeches/2001/english/20010219_youngpeoplealcohol.en.html WHO European Ministerial Conference on Young People and Alcohol]</ref><ref>[http://www.who.int/mediacentre/news/releases/2003/pr6/en/index.html WHO to meet beverage company representatives to discuss health-related alcohol issues]</ref>
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A 2002 study by the [[National Institute on Alcohol Abuse and Alcoholism]] surveyed a group of 4,422 adult alcoholics and found that after one year some were no longer alcoholics, even though only 25.5% of the group received any treatment,<ref name="NIAAA2002">[[National Institute on Alcohol Abuse and Alcoholism]] [http://www.nih.gov/news/pr/jan2005/niaaa-18.htm 2001-2002 Survey Finds That Many Recover From Alcoholism] Press release 18 January 2005.</ref> with the breakdown as follows:
* 25% still dependent
* 27.3% in partial remission (some symptoms persist)
* 11.8% asymptomatic drinkers (consumption increases chances of relapse)
* 35.9% fully recovered — made up of 17.7% low-risk drinkers plus 18.2% abstainers.
In contrast, however, the results of a long term (60 year) follow-up of two groups of alcoholic men by George Vaillant at Harvard Medical School indicated that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence."<ref>{{cite journal | author=Vaillant GE | title= A 60-year follow-up of alcoholic men | journal=Addiction. | year=2003 | volume=98 |pages=1043–51 |pmid=12873238 | doi=10.1046/j.1360-0443.2003.00422.x}}</ref> Vaillant also noted that "return-to-controlled drinking, as reported in short-term studies, is often a mirage."
== Identification and diagnosis ==
Multiple tools are available to those wishing to conduct screening for alcoholism. Identification of alcoholism may be difficult because there is no detectable physiologic difference between a person who drinks frequently and a person with the condition. Identification involves an objective assessment regarding the damage that imbibing alcohol does to the drinker's life compared with the subjective benefits the drinker perceives from consuming alcohol. While there are many cases where an alcoholic's life has been significantly and obviously damaged, there are always borderline cases that can be difficult to classify. Unless they have M.C. type symptoms, and in these cases are probably alcoholics, no diagnosis needed.
''[[Addiction Medicine]]'' specialists have extensive training with respect to diagnosing and treating patients with alcoholism.
=== Screening ===
Several tools may be used to detect a loss of control of alcohol use. These tools are mostly [[self report study|self reportreports]]s in questionnaire form. Another common theme is a score or tally that sums up the general severity of alcohol use.
* The [[CAGE questionnaire]], named for its four questions, is one such example that may be used to screen patients quickly in a doctor's office.
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At least one genetic test exists for an allele that is correlated to alcoholism and opiate addiction.<ref>New York Daily News (William Sherman) [http://www.nydailynews.com/city_life/health/story/390607p-331333c.html Test targets addiction gene] 11 February 2006</ref> Human dopamine receptor genes have a detectable variation referred to as the DRD2 TaqI polymorphism. Those who possess the [[Allele|A1 allele]] (variation) of this polymorphism have a small but significant tendency towards addiction to opiates and endorphin releasing drugs like alcohol.<ref>{{cite journal |author=Berggren U, Fahlke C, Aronsson E, ''et al'' |title=The taqI DRD2 A1 allele is associated with alcohol-dependence although its effect size is small |journal=Alcohol and alcoholism (Oxford, Oxfordshire) |volume=41 |issue=5 |pages=479–85 |year=2006 |pmid=16751215 |doi=10.1093/alcalc/agl043 |url=}}</ref> Although this allele is slightly more common in alcoholics and opiate addicts, it is not by itself an adequate predictor of alcoholism, and some researchers argue that evidence for DRD2 is contradictory.<ref name="Nurnberger"/>
=== DSM diagnosis ===
The [[DSM-IV]] diagnosis of alcohol dependence represents one approach to the definition of alcoholism. In part this is to assist in the development of research protocols in which findings can be compared with one another. According to the DSM-IV, an alcohol dependence diagnosis is:
{{quote|...maladaptive alcohol use with clinically significant impairment as manifested by at least three of the following within any one-year period: tolerance; withdrawal; taken in greater amounts or over longer time course than intended; desire or unsuccessful attempts to cut down or control use; great deal of time spent obtaining, using, or recovering from use; social, occupational, or recreational activities given up or reduced; continued use despite knowledge of physical or psychological [[sequela]]e.}}
=== Urine and blood tests ===
There are reliable tests for the actual use of alcohol, one common test being that of [[blood alcohol content]] (BAC). These tests do not differentiate alcoholics from non-alcoholics; however, long-term heavy drinking does have a few recognizable effects on the body, including:
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However, none of these blood tests for biological markers are as sensitive as screening questionaires.
== Effects ==
{{Main|Long-term effects of alcohol}}
The 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. Alcoholics have a very high suicide rate and studies show between 8% and 21% of alcoholics commit suicide. Alcoholism also has a significant adverse impact on mental health. The risk of suicide among alcoholics has been determined to be 5080 times that of the general public.<ref>{{cite journal |author=Kendall RE |journal=Subst Alcohol Actions Misuse |title=Alcohol and suicide |year=1983 |volume=4 |issue=2-3 |pages=121–7 |pmid=6648755 }}</ref>
=== Physical health effects ===
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]], [[Wernicke-Korsakoff syndrome|alcoholic dementia]], heart disease, increased chance of cancer, nutritional deficiencies, [[sexual dysfunction]], and death from many sources.
=== Mental health effects ===
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 alcohol]] misuse.
Psychiatric disorders are common in alcoholics, especially anxiety and depression disorders, with as many as 25% of alcoholics presenting with severe psychiatric disturbances. Typically these psychiatric symptoms caused by alcohol misuse initially worsen during alcohol withdrawal but with abstinence these psychiatric symptoms typically gradually improve or disappear altogether.<ref>{{cite journal |author=Wetterling T |coauthors=Junghanns K |journal=Eur Psychiatry |title=Psychopathology of alcoholics during withdrawal and early abstinence |year=2000 |month=September |volume=15 |issue=8 |pages=483–8 |pmid=11175926 |doi=10.1016/S0924-9338(00)00519-8 }}</ref> [[Panic disorder]] can develop as a direct result of long term alcohol misuse. Panic disorder can also worsen or occur as part of the [[alcohol withdrawal syndrome]].<ref>{{cite journal |author=Cowley DS |journal=Am J Med |title=Alcohol abuse, substance abuse, and panic disorder |date= January 24, 1992 |volume=92 |issue=1A |pages=41S–48S |pmid=1346485 |doi=10.1016/0002-9343(92)90136-Y }}</ref> Chronic alcohol misuse can cause panic disorder to develop or worsen an underlying panic disorder via distortion of the neurochemical system in the brain.<ref>{{cite journal |author=Cosci F |coauthors=Schruers KR, Abrams K, Griez EJ |journal=J Clin Psychiatry |title=Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship |year=2007 |month=June |volume=68 |issue=6 |pages=874–80 |pmid=17592911 }}</ref>
=== Social effects ===
The social problems arising from alcoholism can be significant. Being drunk or hung over during work hours can result in [[Termination of employment|loss of employment]], which can lead to financial problems including the loss of living quarters. Drinking at inappropriate times, and behavior caused by reduced judgment, can lead to legal consequences, such as criminal charges for [[drunk driving]] or public disorder, or civil penalties for [[tort]]ious behavior. An alcoholic's behavior and mental impairment while drunk can profoundly impact surrounding family and friends, possibly leading to [[marriage|marital conflict]] and [[divorce]], or contributing to [[domestic violence]]. This can contribute to lasting damage to the emotional development of the alcoholic's children, even after they reach adulthood. The alcoholic could suffer from loss of respect from others who may see the problem as self-inflicted and easily avoided.
== Alcohol withdrawal ==
{{Main|Alcohol withdrawal syndrome}}
[[Alcohol withdrawal syndrome|Alcohol withdrawal]] differs significantly from most other drugs in that it can be directly fatal. Drugs which have a similar mechanism of action to alcohol also have a similar risk of causing death during withdrawal, including barbiturate and [[benzodiazepine withdrawal]]. For example it is extremely rare for [[heroin]] or [[cocaine]] withdrawal to be fatal. When people die from heroin or cocaine withdrawal they typically have serious underlying health problems which are made worse by the strain of acute withdrawal. An alcoholic however, who has no serious health issues has a significant risk of dying from the direct effects of withdrawal if it is not properly managed.
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Acute withdrawal symptoms tend to subside after 1 - 3 weeks. Less severe symptoms (e.g. [[insomnia]] and anxiety) may continue as part of a [[post withdrawal syndrome]] gradually improving with abstinence for a year or more. Withdrawal symptoms begin to subside as the body and central nervous system makes adaptations to reverse tolerance and restore GABA function towards normal. Other neurotransmitter systems are involved, especially [[glutamate]] and [[NMDA]].
== Treatments ==
Treatments for alcoholism are quite varied because there are multiple perspectives for the condition itself. Those who approach alcoholism as a medical condition or disease recommend differing treatments than, for instance, those who approach the condition as one of social choice.
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Other colleges and universities now are able to replicate Texas Tech's program thanks to a curriculum developed by the Center using federal funding; Center officials already have assisted or advised in establishing recovery communities on campuses including the [[University of Colorado at Boulder]], [[the University of Texas]] and [[Kennesaw State University]] in [[Georgia (U.S. state)|Georgia]].<ref>http://www.depts.ttu.edu/hs/csa/replication_model.php</ref>
=== Effectiveness ===
When considering the effectiveness of treatment options, one must consider the success rate based on those who enter a program, not just those who complete it. Since completion of a program is the qualification for success, success among those who complete a program is generally near 100%. It is also important to consider not just the rate of those reaching treatment goals but the rate of those relapsing. Results should also be compared to the roughly 5% rate at which people will quit on their own.<ref>{{cite journal |author=Smart RG |title=Spontaneous recovery in alcoholics: a review and analysis of the available research |journal=Drug and alcohol dependence |volume=1 |issue=4 |pages=277–85 |year=1976 |month=April |pmid=797563 |doi=10.1016/0376-8716(76)90023-5 |url=}}</ref> A year after completing a rehab program, about a third of alcoholics are sober, an additional 40 percent are substantially improved but still drink heavily on occasion, and a quarter have completely relapsed.<ref>Based on information from Dr. Mark Willenbring of the [[National Institute on Alcohol Abuse and Alcoholism]], the February 2007 issue of ''Newsweek'' - Adler, Jerry; Underwood, Anne; Kelley, Raina; Springen, Karen; Breslau, Karen. "[http://www.msnbc.msn.com/id/17083397/site/newsweek/page/0/ Rehab Reality Check]" ''Newsweek'', 2/19/2007, Vol. 149 Issue 8, p44-46, 3p, 4c</ref>
=== Detoxification ===
{{main|Alcohol detoxification}}
[[Alcohol detoxification]] or 'detox' for alcoholics is an abrupt stop of alcohol drinking coupled with the substitution of drugs that have similar effects to prevent [[Alcohol withdrawal syndrome|alcohol withdrawal]].
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Detoxification treats the physical effects of prolonged use of alcohol, but does not actually treat alcoholism. After detox is complete, relapse is likely without further treatment. These rehabilitations (or 'rehabs') may take place in an [[Inpatient#Outpatient vs inpatient|inpatient or outpatient]] setting.
=== Group therapy and psychotherapy ===
[[Imageकिपा:Alcoholics Anonymous Regional Service Center by David Shankbone.jpg|thumb|A regional service center for [[Alcoholics Anonymous]].]]
After detoxification, various forms of [[group therapy]] or [[psychotherapy]] can be used to deal with underlying psychological issues that are related to alcohol addiction, as well as provide relapse prevention skills.
The mutual-help group-counseling approach is one of the most common ways of helping alcoholics maintain sobriety. Many organizations have been formed to provide this service. [[Alcoholics Anonymous]] was the first group, and has more members than all other programs combined. Some of the others include [[LifeRing Secular Recovery]], [[Rational Recovery]], [[SMART Recovery]], and [[Women For Sobriety]].
=== Rationing and moderation ===
Rationing and moderation programs such as [[Moderation Management]] and DrinkWise do not mandate complete abstinence. While most alcoholics are unable to limit their drinking in this way, some return to moderate drinking. A 2002 U.S. study by the [[National Institute on Alcohol Abuse and Alcoholism]] (NIAAA) showed that 17.7% of individuals diagnosed as alcohol dependent more than one year prior returned to low-risk drinking. However, this group showed fewer initial symptoms of dependency.<ref>{{cite journal |author=Dawson DA, Grant BF, Stinson FS, Chou PS, Huang B, Ruan WJ |title=Recovery from DSM-IV alcohol dependence: United States, 2001-2002 |journal=Addiction (Abingdon, England) |volume=100 |issue=3 |pages=281–92 |year=2005 |month=March |pmid=15733237 |doi=10.1111/j.1360-0443.2004.00964.x |url=}}</ref> A follow-up study, using the same NESARC subjects that were judged to be in remission in 2001-2002, examined the rates of return to problem drinking in 2004-2005. The major conclusion made by the authors of this NIAAA study was "Abstinence represents the most stable form of remission for most recovering alcoholics".<ref>{{cite journal |author=Dawson DA, Goldstein RB, Grant BF |title=Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up |journal=Alcoholism, clinical and experimental research |volume=31 |issue=12 |pages=2036–45 |year=2007 |month=December |pmid=18034696 |doi=10.1111/j.1530-0277.2007.00536.x |url=}}</ref>
=== Medications ===
A variety of medications may be prescribed as part of treatment for alcoholism.
* ''[[Antabuse]]'' ([[disulfiram]]) prevents the elimination of [[acetaldehyde]], a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many [[hangover]] symptoms from alcohol use. The overall effect is severe discomfort when alcohol is ingested: an extremely fast-acting and long-lasting uncomfortable hangover. This discourages an alcoholic from drinking in significant amounts while they take the medicine. A recent 9-year study found that incorporation of supervised disulfiram and a related compound [[carbamide]] into a comprehensive treatment program resulted in an abstinence rate of over 50%.<ref>{{cite journal |author=Krampe H, Stawicki S, Wagner T, ''et al'' |title=Follow-up of 180 alcoholic patients for up to 7 years after outpatient treatment: impact of alcohol deterrents on outcome |journal=Alcoholism, clinical and experimental research |volume=30 |issue=1 |pages=86–95 |year=2006 |month=January |pmid=16433735 |doi=10.1111/j.1530-0277.2006.00013.x |url=}}</ref>
* ''[[Naltrexone]]'' is a [[competitive antagonist]] for opioid receptors, effectively blocking our ability to use endorphins and opiates. Naltrexone is used in two very different forms of treatment. The first treatment uses naltrexone to decrease cravings for alcohol and encourage abstinence. The other treatment, called [[Sinclair Method|pharmacological extinction]], combines naltrexone with normal drinking habits in order to reverse the endorphin conditioning that causes alcohol addiction. <br />Naltrexone comes in two forms. Oral naltrexone, originally but no longer available as the brand ReVia, is a pill form and must be taken daily to be effective. [[Vivitrol]] is a time-release formulation that is injected in the buttocks once a month.
* ''[[Acamprosate]]'' (also known as [[Campral]]) is thought to stabilize the chemical balance of the brain that would otherwise be disrupted by alcoholism. The [[Food and Drug Administration]] (FDA) approved this drug in 2004, saying "While its mechanism of action is not fully understood, Campral is thought to act on the brain pathways related to alcohol abuse... Campral proved superior to placebo in maintaining abstinence for a short period of time..."<ref>{{cite web| title=FDA Approves New Drug for Treatment of Alcoholism | accessdate=2006-04-02 | url=http://www.fda.gov/bbs/topics/answers/2004/ANS01302.html}}"</ref> The COMBINE study was unable to demonstrate efficacy for Acamprosate.<ref>{{cite web | title=Naltrexone or Specialized Alcohol Counseling an Effective Treatment for Alcohol Dependence When Delivered with Medical Management | year=2006-05-02 | url=http://www.niaaa.nih.gov/NewsEvents/NewsReleases/COMBINERelease.htm}}</ref>
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* ''[[Topiramate]]'' (brand name Topamax), a derivative of the naturally occurring sugar monosaccharide D-fructose, has been found effective in helping alcoholics quit or cut back on the amount they drink. In one study heavy drinkers were six times more likely to remain abstinent for a month if they took the medication, even in small doses.<ref>{{cite journal |author=Johnson BA, Ait-Daoud N, Bowden CL, ''et al'' |title=Oral topiramate for treatment of alcohol dependence: a randomised controlled trial |journal=Lancet |volume=361 |issue=9370 |pages=1677–85 |year=2003 |month=May |pmid=12767733 |doi=10.1016/S0140-6736(03)13370-3 |url=}}</ref><ref>{{cite journal |author=Swift RM |title=Topiramate for the treatment of alcohol dependence: initiating abstinence |journal=Lancet |volume=361 |issue=9370 |pages=1666–7 |year=2003 |month=May |pmid=12767727 |doi=10.1016/S0140-6736(03)13378-8 |url=}}</ref> In another study, those who received topiramate had fewer heavy drinking days, fewer drinks per day and more days of continuous abstinence than those who received the placebo.<ref>{{cite journal |author=Johnson BA, Rosenthal N, Capece JA, ''et al'' |title=Topiramate for treating alcohol dependence: a randomized controlled trial |journal=JAMA : the journal of the American Medical Association |volume=298 |issue=14 |pages=1641–51 |year=2007 |month=October |pmid=17925516 |doi=10.1001/jama.298.14.1641 |url=}}</ref> Topiramate works by reducing dopamine so that drinkers no longer get any pleasure from consuming alcohol and is the only medication shown to be effective for persons who are still drinking.
=== Dual addictions ===
Alcoholics may also require treatment for other psychotropic drug addictions. The most common dual addiction in alcoholics is a [[benzodiazepine dependence]] with studies showing 10 - 20% of alcoholics having problems of dependence and/or misuse problems of [[benzodiazepines]]. Dependence on other sedative hypnotics such as [[zolpidem]] and [[zopiclone]] as well as [[opiates]] also occurs as well as illegal drugs. [[Benzodiazepine withdrawal]] can like alcohol be medically severe and include the risk of [[psychosis]] and [[seizures]] if not managed properly.<ref>{{cite journal |author=Johansson BA, Berglund M, Hanson M, Pöhlén C, Persson I |title=Dependence on legal psychotropic drugs among alcoholics |journal=Alcohol Alcohol. |volume=38 |issue=6 |pages=613–8 |year=2003 |pmid=14633651 |doi= |url=http://alcalc.oxfordjournals.org/cgi/reprint/38/6/613 |format=PDF}}</ref> [[Benzodiazepine]] dependency requires careful reduction in dosage to avoid serious withdrawal and health consequences.
== Women and alcoholism ==
Alcoholism has a higher prevalence among men, though in recent decades, the number of female alcoholics has increased.<ref>{{cite journal |author=Walter H., Gutierrez K., Ramskogler K., Hertling I., Dvorak A., Lesch O.M., ''et al'' |title=gender-specific differences in alcoholism: implications for treatment |journal=Archives of Women's Mental Health |volume=6 |pages=253–268 |year=2003 |month=June |doi=10.1007/s/00737-003-0014-8 |url=}}</ref> It is important to articulate the different biological and social ways alcoholism manifests in women in order to understand barriers to treatment and effective recovery strategies.
=== Biological differences and physiological effects ===
Biologically, women have symptom profiles from their alcohol use that differ in important ways from men. They experience a telescoping of physiological effects from alcohol use. Equal dosages of alcohol consumed by men and women generally result in women having higher blood alcohol concentrations (BACs).<ref>{{cite journal |author=Karrol Brad R. |title=women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners |journal=Journal of social work |volume=2 |issue=3 |pages=337–356 |year=2002 |month= |pmid= |doi=1468-0173(200212)2:3;337-356;029430 |url=}}</ref> This can be attributed to many reasons, the main being that women have less body water than men. A given amount of alcohol, therefore becomes more highly concentrated in a woman's body. Besides this fact, women also become more intoxicated, which is due to different hormone release.<ref>{{cite journal |author=Walter H., Gutierrez K., Ramskogler K., Hertling I., Dvorak A., Lesch O.M., ''et al'' |title=gender-specific differences in alcoholism: implications for treatment |journal=Archives of Women's Mental Health |volume=6 |pages=253–268 |year=2003 |month=June |doi=10.1007/s/00737-003-0014-8 |url=}}</ref>
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Women develop long-term complications of alcohol dependence more rapidly then do alcoholic men. Additionally, women have a higher mortality rate from alcoholism than men.<ref>{{cite journal |author=Blume Laura N., Nielson Nancy H., Riggs Joseph A., ''et all'' |title=Alcoholism and alcohol abuse among women: report of the council on scientific affairs |journal=Journal of women's health |volume=7 |issue=7 |pages=861–870 |year=1998 |month= |pmid= |doi= |url=}}</ref> Examples of long term complications include brain, heart, and liver damage<ref>{{cite journal |author=Walter H., Gutierrez K., Ramskogler K., Hertling I., Dvorak A., Lesch O.M., ''et al'' |title=gender-specific differences in alcoholism: implications for treatment |journal=Archives of Women's Mental Health |volume=6 |pages=253–268 |year=2003 |month=June |doi=10.1007/s/00737-003-0014-8 |url=}}</ref> and an increased risk for 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, irregular menses, amenorrhea, luteal phase dysfunction, and early menopause.<ref>{{cite journal |author=Blume Laura N., Nielson Nancy H., Riggs Joseph A., ''et all'' |title=Alcoholism and alcohol abuse among women: report of the council on scientific affairs |journal=Journal of women's health |volume=7 |issue=7 |pages=861–870 |year=1998 |month= |pmid= |doi= |url=}}</ref>
=== Psychological and emotional effects ===
Psychiatric disorders are generally more prevalent among those with alcohol disorders. This is true for both men and women, however the disorders differ depending on gender. Women who have alcohol-use disorders have 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 co-occurring diagnosis of narcissistic and antisocial personality disorders, bipolar disorder, schizophrenia, impulse disorders and attention deficit/ hyperactivity disorder.<ref>{{cite journal |author=Karrol Brad R. |title=women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners |journal=Journal of social work |volume=2 |issue=3 |pages=337–356 |year=2002 |month= |pmid= |doi=1468-0173(200212)2:3;337-356;029430 |url=}}</ref>
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Women with alcoholism are also more likely to have a history of physical or sexual assault, abuse and domestic violence than those in the general population.<ref>{{cite journal |author=Karrol Brad R. |title=women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners |journal=Journal of social work |volume=2 |issue=3 |pages=337–356 |year=2002 |month= |pmid= |doi=1468-0173(200212)2:3;337-356;029430 |url=}}</ref> This trauma can lead to higher instances of PTSD, depression, anxiety, and a greater dependence on alcohol.
=== Societal barriers to treatment ===
Attitudes and social stereotypes about women and alcohol can create barriers to the detection and treatment of female alcohol abusers. Such beliefs stigmatize women who drink by characterizing them as "both generally and sexually immoral" or the "fallen women." Fear of stigmatization may lead women to deny that they are suffering from a medical condition, to hide their drinking, and to drink alone. This pattern, in turn, leads family, physicians, and others to be less likely to suspect that a woman they know is an alcoholic.<ref>{{cite journal |author=Blume Laura N., Nielson Nancy H., Riggs Joseph A., ''et all'' |title=Alcoholism and alcohol abuse among women: report of the council on scientific affairs |journal=Journal of women's health |volume=7 |issue=7 |pages=861–870 |year=1998 |month= |pmid= |doi= |url=}}</ref>
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Women also tend to have a greater fear that the negative implications from the stigma will reflect poorly on their families. This may also keep them from seeking help.<ref>{{cite journal |author=Karrol Brad R. |title=women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners |journal=Journal of social work |volume=2 |issue=3 |pages=337–356 |year=2002 |month= |pmid= |doi=1468-0173(200212)2:3;337-356;029430 |url=}}</ref>
=== Implications for treatment ===
Research has indicated a lack of adequate training for practitioners both in problematic alcohol use in general, and in relation to women's issues.<ref>{{cite journal |author=Karrol Brad R. |title=women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners |journal=Journal of social work |volume=2 |issue=3 |pages=337–356 |year=2002 |month= |pmid= |doi=1468-0173(200212)2:3;337-356;029430 |url=}}</ref> The complexity of alcohol use disorders, particularly with gender-related issues, indicates that the need for practitioners' knowledge, insight and compassion is enormous.<ref>{{cite journal |author=Karrol Brad R. |title=women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners |journal=Journal of social work |volume=2 |issue=3 |pages=337–356 |year=2002 |month= |pmid= |doi=1468-0173(200212)2:3;337-356;029430 |url=}}</ref> Better education and awareness surrounding the gender implications of alcoholism will help care providers to adequately treat women who suffer from alcoholism. Early intervention will also increase the probability of recovery.
== Societal impact ==
The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to society, for example, money due to lost labor-hours, medical costs, and secondary treatment costs. Alcohol use is a major contributing factor for [[head injury|head injuries]], [[motor vehicle accident]]s, violence, and assaults. Beyond money, there is also the [[pain and suffering]] of the individuals besides the alcoholic affected. For instance, alcohol consumption by a pregnant woman can lead to [[Fetal alcohol syndrome]],<ref>CDC. (2004). ''Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis''. Can be downloaded at http://www.cdc.gov/fas/faspub.htm</ref> an incurable and damaging condition.<ref>Streissguth, A. (1997). ''Fetal Alcohol Syndrome: A Guide for Families and Communities''. Baltimore: Brookes Publishing. ISBN 1-55766-283-5.</ref>
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A study quantified the cost to the UK of ''all'' forms of alcohol misuse as £18.5–20 billion annually (2001 figures).<ref>{{cite web | publisher=BBC | url=http://news.bbc.co.uk/1/hi/health/3122244.stm | title=Q&A: The costs of alcohol | date=2003-09-19 }}</ref><ref name=cosu/>
=== Stereotypes ===
[[Imageकिपा:Imlauer Ihr zu Fuessen 1883.jpg|thumb|right|175px|Depiction of a wino or town drunk]]
[[Stereotype]]s of alcoholics are often found in [[fiction]] and [[popular culture]]. The '[[town drunk]]' is a [[stock character]] in Western popular culture.
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On the other hand, studies by social psychologists Stivers and Greeley<ref>{{cite book |author=Stivers, Richard |title=Hair of the dog: Irish drinking and its American stereotype |publisher=Continuum |location=London |year=2000 |pages= |isbn=0-8264-1218-1}}</ref> attempt to document the perceived prevalence of high alcohol consumption amongst the Irish in America.
== In film and literature ==
In modern times, the recovery movement has led to more realistic depictions of problems that stem from heavy alcohol use. Authors such as [[Charles R. Jackson]] and [[Charles Bukowski]] describe their own alcohol addiction in their writings. The disjoined narrative of [[Patrick Hamilton (dramatist)|Patrick Hamilton]]'s ''[[Hangover Square]]'' reflects the alcoholism of its central character. A famous depiction of alcoholism, and the psychology of an alcoholic, is in Malcolm Lowry's widely acclaimed novel [[Under the Volcano]], which details the final day of the [[British people|British]] [[consul]] Geoffrey Firmin on the [[Day of the Dead]] in 1939 Mexico and his choice to continue his extreme alcohol consumption instead of returning to the wife he loves.
Films like ''[[Bad Santa]]'', ''[[Days of Wine and Roses (film)|Days of Wine and Roses]]'', ''[[My Name is Bill W.]]'', ''[[Withnail and I]]'', ''[[Arthur (film)|Arthur]]'', ''[[Leaving Las Vegas]]'', ''[[Shattered Spirits]]'' and ''[[The Lost Weekend (film)|The Lost Weekend]]'', chronicle similar stories of alcoholism.
== Politics and public health ==
{{details|Addiction recovery groups}}
Because alcohol use disorders are perceived as impacting society as a whole, governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism. The [[World Health Organization]], the [[European Union]] and other regional bodies are working on alcohol action plans and programs.
== See also ==
* [[Alcohol consumption and health]]
* [[Alcoholism in family systems]]
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** [[Liver function tests]]
== References ==
== Further reading ==
* {{cite book
|last=Alasuutari |first=Pertti
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* {{cite book
|last=Beauchamp |first=Dan E.
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* Berry, Ralph E.; Boland James P. ''The Economic Cost of Alcohol Abuse'' The Free Press, New York, 1977 ISBN 0-02-903080-3
* {{cite book
|last=Browman |first=K. E. and J. C. Crabbe
|editor=Neil J. Smelser and Paul B. Baltes
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* {{cite book
|last=Clark |first=Walter B. and Michael E. Hilton
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* {{cite book
|last=Díaz |first=Héctor Luis and Thomas D. Watts
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* {{cite book
|last=Fingarette |first=Herbert
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* {{cite book
|last=Galanter |first=Marc
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|oclc=133155628 56653179 57724687 71290784}}
* {{cite book
|last=Goodwin |first=Donald W.
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|oclc=41834977 42622081 57339357 57621778 70861649}}
* {{cite book
|last=Gusfield |first=Joseph R.
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* {{cite book
|last=Hedblom |first=Jack H.
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|oclc=237901552 77708730}}
* {{cite book
|last=Helzer |first=John E. and Glorisa J. Canino
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|oclc=22813697 231433712}}
* {{cite book
|last=Holder |first=Harold D.
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|oclc=36900925 41499013 86004981}}
* {{cite book
|last=Klingemann |first=Harald, Jukka-Pekka Takala, and Geoffrey Hunt
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* {{cite book
|last=Kunitz |first=Stephen J., Jerrold E. Levy, and Tracy J. Andrews
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* {{cite book
|last=Lindstrom |first=Lars
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|oclc=185499265 24467909 26316175}}
* {{cite book
|last=Mack |first=Avram H. John E. Franklin, and Richard J. Frances
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* {{cite book
|last=Mayes |first=A.
|editor=Neil J. Smelser and Paul B. Baltes
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* Milam, Dr. James R. and Ketcham, Katherine ''Under The Influence: A Guide to the Myths and Realities of Alcoholism.'' Bantam, 1983, ISBN 0-553-27487-2
* {{cite book
|last=Moos |first=Rudolf H., John W Finney, and Ruth C Cronkite
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|oclc=20168177 231158156}}
* {{cite book
|last=Murphy |first=George E.
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|oclc=243735768 24378872}
* National Institute on Alcohol Abuse and Alcoholism. [http://pubs.niaaa.nih.gov/publications/Social/Module2Etiology&NaturalHistory/Module2.html Etiology and Natural History of Alcoholism].
* {{cite book
|last=O'Farrell |first=Timothy J. and William Fals-Stewart
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* {{cite book
|last=O'Reilly |first=Edmund B.
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* Pence, Gregory, "Kant on Whether Alcoholism is a Disease," Ch. 2, The Elements of Bioethics, McGraw-Hill Books, 2007 ISBN 0-07307-13277313277-2.
* {{cite book
|last=Perkinson |first=Robert R.
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|oclc=54905506 56645146 70720151}}
* {{cite book
|last=Plant |first=Martin A. and Moira Plant
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* Royce, James E. and Scratchley, David ''Alcoholism and Other Drug Problems'' Free Press, March 1996 ISBN 0-684-82314-4 ISBN 978-0-684-82314-0
* {{cite book
|last=Saggers |first=Sherry and Dennis Gray
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* {{cite book
|last=Smart |first=Lesley
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* {{cite book
|last=Soyka |first=M.
|editor=Neil J. Smelser and Paul B. Baltes
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* {{cite book
|last=Stimmel |first=Barry
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|oclc=46575047 52287994 59502027}}
* {{cite book
|last=Sutton |first=Philip M.
|editor=Michael L. Coulter, Stephen M. Krason, Richard S. Myers, and Joseph A. Varacalli
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* {{cite book
|last=Thatcher |first=Richard
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* {{cite book
|last=Tracy |first=Sarah W.
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* Valliant, George E., ''[[The Natural History of Alcoholism Revisited]], Harvard University Press, May 1995 ISBN 0-674-60378-8 ISBN 978-0-674-60378-3
* Warren Thompson, MD, FACP. "[http://www.emedicine.com/med/topic98.htm Alcoholism]." Emedicine.com, June 6, 2007. Retrieved 2007-09-02.
* {{cite book
|last=Watts |first=Thomas D. and Roosevelt Wright, Jr.
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* {{cite book
|last=Watts |first=Thomas D. and Roosevelt Wright, Jr.
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* {{cite book
|last=Weinberg |first=Thomas S.
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== पिनेया स्वापू ==
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