Alcoholism

The use of alcohol is woven into our culture in a most complex fashion. The majority of adults in the United States consume alcohol, yet alcohol also causes nearly 100,000 deaths per year and cost the society $223.5 billion in 2006 alone. Harm from alcohol can occur in a number of ways. First, if alcohol is consumed above a certain threshold, on the order of one drink/day for a woman or two drinks/day for a man, medical consequences, e.g. hypertension, cirrhosis, or depression, can occur over time. Second, if alcohol is consumed to the point of intoxication and impairment, the risk of domestic violence and child abuse, motor vehicle accidents, criminal behavior, and problems at work or school are greatly increased. Third, in susceptible individuals, alcohol use leads to the development of a true addiction to alcohol-alcoholism. Alcoholism is characterized by loss of control over alcohol use, compulsive use, and the development of physical dependence. The negative consequences of alcoholism are generally severe. Alcoholism, or alcohol dependence, was first suggested to be a disease in the 1780s but only recognized as such by the American Medical Association in 1958. The diagnostic criteria for alcoholism have shifted somewhat over time but the core elements of loss of control, compulsive use despite adverse consequences, and physical dependence remain. Alcoholism is a common disorder with a lifetime prevalence of 20% in men and 10-15% in women (1). The etiology of alcoholism involves biopsychosocial components with an estimated 50% of risk coming from genetics. Alcoholism and unhealthy alcohol use are under-recognized by clinicians though a variety of medical symptoms and laboratory findings or positive answers to simple questions should alert the clinician to alcohol-related problems. Alcoholism should be viewed as a chronic disease; individuals are not "cured". However, alcoholism is a treatable disorder and many patients achieve long-term sobriety or greatly reduce their use of alcohol. Treatments for alcoholism include a variety of psychosocial techniques such as brief intervention, relapse-prevention therapy, and traditional residential programs. Alcoholics Anonymous is a self-help organization that has helped many alcoholics. Recently, medications that target neurobiological factors involved in relapse have become available-naltrexone and acamprosate. The evolving treatment of alcoholism includes an integration of psychosocial interventions with medication coupled with awareness that treatment requires long-term management.