Alcohol consumption as a Health care Challenge
What is Alcohol Dependence
The DSM-IV (American Psychiatric Association, 1994) diagnostic term for alcoholism is alcohol dependence. Although many people still use the older term "alcoholism." Alcohol dependence is a chronic relapsing disease involving craving for, loss of control over, physical dependence on, and higher than normal tolerance for alcohol.
Consequences Or Effects
The excessive intake of alcohol over time leads to social, emotional, and physical damage to health, interpersonal/ familial relationships, and occupational status. It is a primary disease with genetic, psychological, lifestyle, and environmental causal influences that have not been adequately differentiated to date.
Alcohol is a depressant drug and continued abuse leads to negative psychological and physical detriments including hypertension, cardiac arrhythmias, cardiomyopathy, hemorrhagic stroke, liver damage, distortions and errors in conceptual thought. processes, memory decrements, depression, increased risk for all types of accidents, and risk for suicide.
Some Health Benefits
Alcohol is a solvent that
permeates all body cells, including the blood-brain barrier, and has
lipid-dissolving qualities. It is this latter quality that leads to findings
that moderate drinking decreases fatty plaques in blood vessels and thus
decreases the risk for heart attacks.
How Measure Alcoholism
Measuring alcohol intake presents research challenges. The amount of alcohol in. a standard drink differs across countries and is made more complex by the fact that beer, wine, and other drinks may contain differing percentages of pure alcohol.
Generally, in the US a standard drink is 12 ounces (oz.) of beer or wine cooler, 5 oz. of wine, or 1.5 oz. of 80 proof distilled spirits; that is, approximately 12 grams of pure alcohol per drink.
Collecting data about alcohol intake is complex; in addition to the basic measure of a standard drink, it is crucial to determine the number of drinks consumed in a week or a month, the duration of the current and any prior patterns of alcohol intake, the number of drinks consumed in one drinking episode (hinge drinking is defined as five or more drinks for a man and four or more for a woman during one episode), and the number of binge episodes during the past month/year.
Although many survey instruments and biomarkers exist to measure the amounts and effects of alcohol intake, no single approach. is valid and reliable for men and women; across age groups; or for differentiating among binge drinking, alcohol abuse, and alcohol dependence. Blood alcohol level only reveals intake within recent hours, but does not inform about recurring or chronic intake.
Carbohydrate deficient transferrin informs about longer term heavy drinking, but has acceptable sensitivity and specificity primarily for young adult and middle-aged men; it is much less valid for older men and for women of all ages. Most other biomarkers are not specific to alcohol effects, but simply report abnormalities in liver enzymes or hematological contents.
There is also a measurement issue
related to abstinence in comparison groups; it is essential to separate out
"sick quitters" from lifelong abstainers or very low quantity users. Otherwise,
the results of studies are contaminated by the presence of subjects with
alcohol-related sequelae (i.e. sick quitters) in the abstainer group.
Most Pron Population
Young adults, especially men, have the highest rate of drinking, binge drinking, and heavy drinking. Women at all ages drink less, but are at higher risk for negative effects of alcohol. The reasons have not been clearly explicated, but lower body water to lipid content and less muscle mass are generally accepted facts.
More controversial is the hypothesis that women produce much less alcohol dehydrogenase, thus increasing the time necessary for first pass metabolism and prolonging the half-life of pure alcohol in body systems.
Whatever the cause, women experience higher levels of cardiac, liver, and other system dysfunctions and psychological distress (depression and suicide attempts) earlier in their drinking histories and at much lower quantities compared to men.
These findings led to the NIAAA (1995) guideline for moderate
drinking of two standard drinks per day for young and middle adult men and one
standard drink per day for non-pregnant women of all ages and elderly men.
Alcoholism and Health Issues
Fetal alcohol syndrome (FAS) and alcohol-related birth defects (ARBD) are manifestations of neurodevelopmental insults that result from alcohol ingestion by the mother during pregnancy. The negative effects are especially marked during periods of fetal brain growth spurts and continue during the. postnatal period for breast-fed infants of drinking mothers.
Consequences of FAS, and the
milder form ARBD, include impaired attention, intelligence, memory, motor
coordination, complex problem solving, and abstract thinking. There are also physical
stigmata that attend FAS including abnormal facial features and other
anatomical alterations (Connor & Streissguth, 1996).
Alcoholism and Ethnicity
Alcohol consumption differs among the three main ethnic groups in the US (Caetano, Clark, & Tan, 1998). In general, frequent heavy drinking and binge drinking has decreased among White men (from 20% in 1984 to 12% in 1995), but has remained stable among Black and Hispanic men (15% and 18% respectively in both years).
Frequent heavy drinking is much less prevalent among all groups of women (2-5%). Within-group differences exist for ethnic minorities depending on where they were born. Asians, Pacific Islanders, and Hispanics who were born in the US have higher rates of heavy drinking than those who immigrated to the US Unfortunately, Blacks and Hispanics.
How to Deal With Alcoholic Addicted
Who have alcohol problems are much less likely to seek treatment compared to Whites. Alcohol dependence is treatable with medication regimens (especially for detoxification), individual and family counseling, support groups, and self-help groups-primarily Alcoholics Anonymous and the 12 Step Program.
Relapses are common, but the key is to get the drinker back into treatment and after-care following each relapse and eventually sobriety can be attained and maintained. Family solidarity is required to stop all cover-ups on behalf of the drinker. It is important that the drinker experience the full consequences of the drinking without being rescued so that continued denial of the effects of the drinking becomes impossible.
The research opportunities in this field are myriad. At the fundamental science level research is needed on the root causes of alcohol dependence including the role of genetics. The reasons for the excess risk among women merit considerably more research attention.
Social, behavioral, and cultural studies are in order to address the many unanswered questions about adolescent drinking, college hinge drinking, late onset alcohol dependence among elders, and differential risk for alcohol problems among ethnic minorities.
Theory based interventions should be developed and tested to enhance the case finding, referral, and successful treatment for adolescents, women, minorities, elderly persons, and white men. In the area of measurement, the current paper and pencil survey instruments are biased toward white men and toward the young and middle aged.
New biomarkers must be developed that are sensitive and specific for women and for older adults. These are but a few of the many areas available for future inquiry.
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