Disorders

ALCOHOL ADDICTION

Alcohol is widely available and consumed in most societies. It has a number of properties that make it popular, including that it is affordable and legalised in most countries, and can improve mood, increase confidence and reduce anxiety. Recommended maximum daily limits range from 3-4 units for men and 2-3 for women, where 1 unit is ½ pint of normal strength beer or 1 small glass of wine, which may be lower if, for example, the individual suffers medical or psychological conditions. Drinking regularly more than these limits increases the likelihood that alcohol will lead to problems with physical and psychological health, social and occupational functioning, and with the law, and can also seriously affect the individual's spouse, family, friends and work colleagues. An addiction is established when there is a compulsion to drink alcohol despite the individual clearly suffering from its harmful consequences, which can be very serious. In the UK alone, problem drinking costs an estimated £20 billion per year and leads to 22,000 premature deaths.

Alcohol misuse/dependence can be classified as follows:

• Acute intoxication – extreme drunkenness
• Heavy drinking – in excess of current guidelines
• Problem drinking or harmful use – affecting the individual's functioning and health
• Dependence syndrome – associated with:
• • Physical urges to drink, i.e. cravings
  • Withdrawal symptoms on reduction of blood alcohol levels
  • Tolerance – requiring more in order to feel the effects
  • Persistent use despite physical and psychological harm
  • Prominence of drinking behaviour over other responsibilities
  • Rapid reinstatement of excessive drinking pattern on relapse

Causes

A number of factors may lead to a person experiencing difficulties with alcohol:

• Biological – 50-60% of the risk of developing problem alcohol consumption or addiction is attributed to genetic factors. Alcohol acts in the reward and survival centres of the brain whereby its consumption becomes strongly correlated with feelings of pleasure, reward or avoidance of negative feelings via its interaction with chemicals in the brain known as neurotransmitters, including Dopamine, Serotonin and GABA (creating the slowing down of mental function). Alcohol intake often increases during times of stress and in some cases is used as 'self-medication' for anxiety-related disorders.
• Psychological – people may seek out the effects of alcohol when they feel anxious, stressed or depressed. If this strategy works in the short-term, they are likely to continue using it and fail to deal with the underlying difficulties. The initial problems usually become more severe as a consequence of their drinking.
• Social – availability and cost of alcohol, normalisation of behaviour by observation of others including family, peer pressure and market forces, are some of the social drivers for consumption.

Treatment

The first aim of treatment is to restore the patient to a normal body weight, learning about proper nutrition in the process.

• Detoxification – people who have become dependent on alcohol will suffer 'withdrawal' symptoms if they stop drinking. These can be severe and, therefore, they will need medical supervision and medication to manage the symptoms.
• Treating underlying mental and physical health problems – since alcohol use can mask other problems it is often necessary to manage these using medical and psychological treatments.
• Medication – some dependent drinkers opt to take medications that either remove alcohol cravings (e.g. acamprasate or naltrexone) or cause sickness upon consumption ('antabuse').
• Psychological therapies – a variety of therapies are used in alcohol treatment. These involve cognitive behaviour therapy (learning to cope better with triggers to drinking), motivational interviewing and 12-step methods, which use the philosophy of alcoholics anonymous (AA) to help individuals maintain abstinence.