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Alcoholism

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(PD) Image: National Institute on Alcohol Abuse and Alcoholism
Images of a 61-year-old healthy man (upper images) and a 60-year-old alcoholic man (lower images). Note on the MRI the thinner corpus callosum displaced upward by enlarged ventricles and, on the DTI, less well delineated white matter tracts in the alcoholic man compared with the healthy man.

Alcoholism is a chronic condition, the development and presentation of which is influenced by genetic, psychosocial, and environmental factors. As a disease process, it is often progressive, and sometimes fatal. Alcoholism is typically characterized by impaired impulse control, preoccupation with alcohol, continued use of alcohol despite adverse consequences, and a generalized distortion in thinking. While the condition itself is considered chronic, the symptom profile may present either continuously or periodically." [1]

Contents

Etiology / cause

Alcoholism is "probably a multifactorial, genetically influenced disorder" and twin studies show a "55% or higher concordance rate in monozygotic twins with only a 28% rate for like-sex dizygotic twins."[2]

Alcoholic styles

Chronic drinking

Maintenance drinking

Binge drinking

Blackout drinking

Recovery styles

The 'dry drunk'

In recovery

Post-recovery

Diagnosis

A systematic review concluded "full AUDIT may be superior to the AUDIT-C."[3]

One question, "'How many times in the past year have you had X or more drinks in a day?', where X is 5 for men and 4 for women, and a response of >1 is considered positive" has accuracy of:[4]

Hair analysis

Hair analysis can detect alcohol consumption by measuring fatty acid ethyl esters and ethyl glucuronide that are metabolites of ethanol.[5][6]

Treatment

Medications

Acamprosate

"Acamprosate appears to be an effective and safe treatment strategy for supporting continuous abstinence after detoxification in alcohol dependent patients" according to the Cochrane Collaboration.[7] In this review, the number needed to treat was about 9 patients.

Baclofen

Baclofen is a selective GABA B-receptor agonist that in a single trial of patients with alcoholic cirrhosis improved abstinence rates (71% versus 29%) over three months.[8]

Disulfiram

A randomized controlled trial showed benefit from disulfiram [9]

Topiramate

Randomized controlled trials of volunteers showed benefit from topiramate.[10][11]

Naltrexone

Randomized controlled trials show conflicting benefit from naltrexone with benefit among recent abstainers[12] and no benefit from chronic users[13].

See also

Alcohol (drug)

References

  1. National Library of Medicine. Alcoholism. Retrieved on 2007-12-06.
  2. Alcohol Dependence. (Online Mendelian Inheritance in Man, OMIM®. Johns Hopkins University, Baltimore, MD. MIM Number: 103780. World Wide Web URL: http://omim.org/.)
  3. Kriston L, Hölzel L, Weiser AK, Berner MM, Härter M (December 2008). "Meta-analysis: are 3 questions enough to detect unhealthy alcohol use?". Ann. Intern. Med. 149 (12): 879–88. PMID 19075207[e]
  4. Smith, Peter; Susan Schmidt, Donald Allensworth-Davies, Richard Saitz (2009-07-01). "Primary Care Validation of a Single-Question Alcohol Screening Test". Journal of General Internal Medicine 24 (7): 783-788. DOI:10.1007/s11606-009-0928-6. PMID 19247718. Retrieved on 2009-06-16. Research Blogging.
  5. Pragst F, Balikova MA (August 2006). "State of the art in hair analysis for detection of drug and alcohol abuse". Clin. Chim. Acta 370 (1-2): 17–49. DOI:10.1016/j.cca.2006.02.019. PMID 16624267. Research Blogging.
  6. Pragst F, Yegles M (April 2008). "Determination of fatty acid ethyl esters (FAEE) and ethyl glucuronide (EtG) in hair: a promising way for retrospective detection of alcohol abuse during pregnancy?". Ther Drug Monit 30 (2): 255–63. DOI:10.1097/FTD.0b013e318167d602. PMID 18367991. Research Blogging.
  7. Rösner S, Hackl-Herrwerth A, Leucht S, Lehert P, Vecchi S, Soyka M (2010). "Acamprosate for alcohol dependence.". Cochrane Database Syst Rev 9: CD004332. DOI:10.1002/14651858.CD004332.pub2. PMID 20824837. Research Blogging.
  8. 2007. Lancet
  9. Fuller RK, Branchey L, Brightwell DR, et al (1986). "Disulfiram treatment of alcoholism. A Veterans Administration cooperative study". JAMA 256 (11): 1449–55. PMID 3528541[e]
  10. Johnson BA, Rosenthal N, Capece JA, Wiegand F, Mao L, Beyers K et al. (2008). "Improvement of physical health and quality of life of alcohol-dependent individuals with topiramate treatment: US multisite randomized controlled trial.". Arch Intern Med 168 (11): 1188-99. DOI:10.1001/archinte.168.11.1188. PMID 18541827. Research Blogging.
  11. Johnson BA, Rosenthal N, Capece JA, Wiegand F, Mao L, Beyers K et al. (2007). "Topiramate for treating alcohol dependence: a randomized controlled trial.". JAMA 298 (14): 1641-51. DOI:10.1001/jama.298.14.1641. PMID 17925516. Research Blogging.
  12. Anton RF, O'Malley SS, Ciraulo DA, et al (2006). "Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial". JAMA 295 (17): 2003–17. DOI:10.1001/jama.295.17.2003. PMID 16670409. Research Blogging.
  13. Krystal JH, Cramer JA, Krol WF, Kirk GF, Rosenheck RA (2001). "Naltrexone in the treatment of alcohol dependence". N. Engl. J. Med. 345 (24): 1734–9. DOI:10.1056/NEJMoa011127. PMID 11742047. Research Blogging.
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