-IBIS-1.5.0-
tx
mental/emotional
alcoholism
diagnoses
definition and etiology
definition:
Alcoholism (or technically " chronic alcoholism") is the physical and emotional dependency on the use of alcohol, the removal of which causes physical and emotional withdrawal.
a situation in which the withholding of alcohol from an individual's
metabolism, causes him or her the pain of physical and emotional withdrawal
the physical and emotional dependence on the presence of alcohol in the bloodstream in order to feel "all right"
the internal feeling or belief that such dependence is somehow right and natural, including a tacit acceptance of the chaotic conditions which may follow
the fundamental template of addictive substance abuse
etiology:
Largely unknown: but genetics, familial tendencies, biochemical factors and sociocultural pressures are all associated:
The development of alcoholism has two distinct elements:
mental/emotional, based on the desire of the patient to reduce awareness of
his or her own internal discomfort through the anesthetic effect of alcohol
physical, based on a combination of physiological damage incurred and
compensatory adjustment developed as a result of the continued use of alcohol
The physical dependence element develops at different rates for different
individuals and effects vary widely. Any human who drinks enough alcohol over
enough time will become alcoholic. For some, it takes large quantities and long periods and for others, small quantities and short periods. It is difficult to predict where any given individual may be on that scale. Genetic predisposition to easy development of alcoholism is evidenced in differing proportions in differing ethnic groups
Alcoholism is known in all parts of the world and is a fundamental disease of western civilization. Evidence now shows that the desire for alcohol appears to have been the basic reason for the first cultivation of grains and the subsequent rise of cities. Bread as a use for grain was discovered only after it was in cultivation for alcohol production.
Some sources suggest that most alcoholics have a decreased ACTH production so they have no stamina or endurance. In almost all cases there is some form of hypoglycemia with a strong epinephrine compensation and those individuals will generally go too long without eating. The only thing that will calm down the adrenaline and go with the sugar is alcohol.
signs and symptoms
There are 31 symptoms of chronic alcoholism. The cardinal ones include:
Tremors
Blackouts
Mood swings upon ingestion
Protecting supply (many alcoholics can hold a job long after they have lost everything else including their family)
A loved one or associate telling the patient they they drink too much
Gulping drinks
Hiding supply
According to research, alcoholism is
chronic: a person may never drink again
primary: other emotional problems will not be responsive until the alcoholism is arrested
progressive: even after the person stops drinking, the disease progresses; if the person drinks again much later the disease is manifested as if they had been drinking all along
fatal: in the absence of treatment, the disease leads to insanity or death
lab findings:
increased GGT
increased anion gap
increased MCV
decreased serum Mg
decreased cholesterol
decreased serum glucose
stomatocytes (transient)
AST/ALT ratio >1, with AST >300 mU/ml identifies 90% of cases with alcoholic liver disease
AST to 300 with normal ALT favors alcoholic liver disease
serum alcohol: cimetidine (Tagamet) inhibits gastric alcohol dehydrogenase, interfering with alcohol breakdown, and substantially increasing serum alcohol levels (DiPadova, et al., JAMA 1992; 267: 83-86)
course and prognosis
One interesting aspect of this dependency is that it initially takes more and more alcohol to attain the desired effects but later takes less. This may be due to liver damage or to impaired psychological function. The course of this disease is best shown on a chart. A line can be drawn to represent feeling neutral. Drinking alcohol allows a person to move above the line toward euphoria with a small price to pay (perhaps) the next day, falling below the line into mild discomfort or pain. As the condition progresses, the person may travel higher into euphoria but falls further into pain or remorse. Later when not drinking, the normal "state of mind" falls below the neutral line and it takes more alcohol to attain the same level of euphoria as previously. Finally the person is so far below the line that they need to drink to keep from feeling pain; to feel normal.
Denial is a hallmark symptom or condition of the disease. Denial of having a problem with alcohol prevents the person from taking successful action. Denial may come in the form of "generalizing" the condition to avoid specifically stating how bad things are; or "minimizing" the extent of the problem.
There is a phenomenon termed 'hitting bottom" in which the person feels enough pain that their walls of denial are cracked. At this point the person is often ready to receive the kind of help that is available, in whatever form it takes.
The recovery rate is poor even among people who seek help. Alcoholics Anonymous, made up of recovering alcoholics, is as successful as any treatment program and there is no fee.
differential diagnosis
Quite frequently, severe emotional problems underlie alcoholism. After the alcoholism has been arrested, work can begin on the other problems. Alcoholism is, however, primary in that emotional growth is arrested while the disease is active or the alcoholic is drinking.
differentiate the signs and symptoms which may mimic other diseases
footnotes