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* [[:en:Alcoholism|en]]
* [[Alkoholisme]]
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{{Infobox medical condition (new)
| name = Alcoholism
| synonyms = Alcohol dependence syndrome, alcohol use disorder (AUD)<ref name=MESH2020/>
| image = King Alcohol and his Prime Minister.jpg
| caption = "King Alcohol and His Prime Minister" {{circa|1820}}
| field = [[Psychiatry]], [[toxicology]], [[addiction medicine]]
| symptoms = Drinking large amounts of alcohol over a long period, difficulty cutting down, acquiring and drinking alcohol taking up a lot of time, usage resulting in problems, [[Alcohol withdrawal syndrome|withdrawal]] occurring when stopping<ref name=NIH2013 />
| complications = [[Mental illness]], [[Delirium tremens|delirium]], [[Wernicke–Korsakoff syndrome]], [[Heart arrhythmia|irregular heartbeat]], [[cirrhosis|cirrhosis of the liver]], [[cancer]], [[fetal alcohol spectrum disorder]], [[suicide]]<ref name=FAS2015/><ref name=DSM5 /><ref name=NIHHx/><ref>{{cite journal |last1=Borges |first1=G |last2=Bagge |first2=CL |last3=Cherpitel |first3=CJ |last4=Conner |first4=KR |last5=Orozco |first5=R |last6=Rossow |first6=I |title=A meta-analysis of acute use of alcohol and the risk of suicide attempt. |journal=Psychological Medicine |date=April 2017 |volume=47 |issue=5 |pages=949–957 |doi=10.1017/S0033291716002841 |pmid=27928972|pmc=5340592 }}</ref>
| onset =
| duration = Long term<ref name=NIH2013 />
| causes = Environmental and genetic factors<ref name=DSM5/>
| risks = [[Stress (biological)|Stress]], anxiety, inexpensive, easy access<ref name=DSM5/><ref name=Moon2012/>
| diagnosis = Questionnaires, [[blood test]]s<ref name=DSM5/>
| differential =
| prevention =
| treatment = [[Alcohol detoxification]] typically with [[benzodiazepine]]s, counselling, [[acamprosate]], [[disulfiram]], [[naltrexone]]<ref name="Morgan-Lopez-2006"/><ref name="Blondell-2005"/><ref name=Test2014/>
| medication =
| prognosis =
| frequency = 208 million / 4.1% adults (2010)<ref name=WHO2014/><ref name=Pew2015/>
| deaths = 3.3 million / 5.9%<ref name=NIH2015Stats/>
| alt =
}}
<!-- Definition and symptoms -->
'''Alcoholism''', also known as '''alcohol use disorder''' ('''AUD'''),<ref name=MESH2020>{{cite web |title=Alcoholism MeSH Descriptor Data 2020 |url=https://meshb.nlm.nih.gov/record/ui?ui=D000437 |website=meshb.nlm.nih.gov |accessdate=9 May 2020}}</ref> is, broadly, any drinking of [[alcohol (drug)|alcohol]] that results in [[Mental health|mental]] or physical [[health]] problems.<ref>{{cite book|first=Jill|last=Littrell|title=Understanding and Treating Alcoholism Volume I: An Empirically Based Clinician's Handbook for the Treatment of Alcoholism: Volume Ii: Biological, Psychological, and Social Aspects of Alcohol Consumption and Abuse|date=2014|publisher=Taylor and Francis|location=Hoboken|isbn=978-1-317-78314-5|page=55|url=https://books.google.com/books?id=2k57AgAAQBAJ&pg=PA55|quote=The World Health Organization defines alcoholism as any drinking which results in problems|url-status=live|archiveurl=https://web.archive.org/web/20170720112756/https://books.google.com/books?id=2k57AgAAQBAJ&pg=PA55|archivedate=20 July 2017}}</ref><ref name="NIH2013" /><ref name="DSM5" /> The disorder was previously divided into two types: [[alcohol abuse]] and [[alcohol dependence]].<ref name=NIH2013>{{cite web|title=Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5|url=http://pubs.niaaa.nih.gov/publications/dsmfactsheet/dsmfact.htm|accessdate=9 May 2015|date=November 2013|url-status=live|archiveurl=https://web.archive.org/web/20150518080640/http://pubs.niaaa.nih.gov/publications/dsmfactsheet/dsmfact.htm|archivedate=18 May 2015}}</ref><ref name=NIH2003>{{cite journal|last1=Hasin|first1=Deborah|title=Classification of Alcohol Use Disorders|volume=27|issue=1|pages=5–17|url=http://pubs.niaaa.nih.gov/publications/arh27-1/5-17.htm|journal=Alcohol Research & Health : The Journal of the National Institute on Alcohol Abuse and Alcoholism|accessdate=28 February 2015|date=December 2003|url-status=live|archiveurl=https://web.archive.org/web/20150318014903/http://pubs.niaaa.nih.gov/publications/arh27-1/5-17.htm|archivedate=18 March 2015|pmid=15301396|pmc=6676702}}</ref> In a medical context, alcoholism is said to exist when two or more of the following conditions are present: a person drinks large amounts of alcohol over a long time period, has difficulty cutting down, acquiring and drinking alcohol takes up a great deal of time, alcohol is strongly desired, usage results in not fulfilling responsibilities, usage results in social problems, usage results in health problems, usage results in risky situations, [[Alcohol withdrawal syndrome|withdrawal]] occurs when stopping, and [[alcohol tolerance]] has occurred with use.<ref name=NIH2013 /> Alcohol use can affect all parts of the body, but it particularly affects the brain, heart, liver, [[pancreas]] and [[immune system]].<ref name=DSM5 /><ref name=NIHHx /> Alcoholism can result in [[mental illness]], [[delirium tremens]], [[Wernicke–Korsakoff syndrome]], [[Heart arrhythmia|irregular heartbeat]], an impaired immune response, liver [[cirrhosis]] and [[alcohol and cancer|increased cancer risk]].<ref name=DSM5 /><ref name=NIHHx>{{cite web|title=Alcohol's Effects on the Body|url=http://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body|accessdate=9 May 2015|url-status=live|archiveurl=https://web.archive.org/web/20150603230352/http://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body|archivedate=3 June 2015|date=14 September 2011}}</ref><ref>{{Cite journal|last1=Romeo|first1=Javier|last2=Wärnberg|first2=Julia|last3=Nova|first3=Esther|last4=Díaz|first4=Ligia E.|last5=Gómez-Martinez|first5=Sonia|last6=Marcos|first6=Ascensión|date=October 2007|title=Moderate alcohol consumption and the immune system: a review|journal=The British Journal of Nutrition|volume=98 Suppl 1|pages=S111–115|doi=10.1017/S0007114507838049|issn=0007-1145|pmid=17922947|doi-access=free}}</ref> Drinking during [[pregnancy]] can result in [[fetal alcohol spectrum disorder]]s.<ref name=FAS2015>{{cite web|title=Fetal Alcohol Exposure|url=http://www.niaaa.nih.gov/alcohol-health/fetal-alcohol-exposure|accessdate=9 May 2015|url-status=live|archiveurl=https://web.archive.org/web/20150404182156/http://www.niaaa.nih.gov/alcohol-health/fetal-alcohol-exposure|archivedate=4 April 2015|date=14 September 2011}}</ref> Women are generally more sensitive than men to the harmful effects of alcohol, primarily due to their smaller body weight, lower capacity to metabolize alcohol, and higher proportion of body fat.<ref name=WHO2014>{{cite book|title=Global status report on alcohol and health 2014|date=2014|publisher=World Health Organization|isbn=978-92-4-069276-3|pages=8, 51|url=http://www.who.int/substance_abuse/publications/global_alcohol_report/msb_gsr_2014_1.pdf?ua=1|url-status=live|archiveurl=https://web.archive.org/web/20150413011848/http://www.who.int/substance_abuse/publications/global_alcohol_report/msb_gsr_2014_1.pdf?ua=1|archivedate=13 April 2015}}</ref>
 
<!-- Cause and diagnosis-->
Environmental factors and genetics are two components associated with alcoholism, with about half the risk attributed to each.<ref name=DSM5/> Someone with a parent or sibling with alcoholism is three to four times more likely to become an alcoholic themselves.<ref name=DSM5/> Environmental factors include social, cultural and behavioral influences.<ref name="Agarwal-Kozlowski-2000">{{cite journal |last1=Agarwal-Kozlowski |first1=K |last2=Agarwal |first2=DP | title = [Genetic predisposition for alcoholism] | journal = Ther Umsch | volume = 57 | issue = 4 | pages = 179–84 | date = April 2000 | pmid = 10804873 | doi = 10.1024/0040-5930.57.4.179 }}</ref> High [[Stress (biological)|stress levels]] and anxiety, as well as alcohol's inexpensive cost and easy accessibility, increase the risk.<ref name=DSM5/><ref name="Moon2012">{{cite journal|last1=Moonat|first1=S|last2=Pandey|first2=SC|title=Stress, epigenetics, and alcoholism|journal=Alcohol Research : Current Reviews|date=2012|volume=34|issue=4|pages=495–505|pmid=23584115|pmc=3860391}}</ref> People may continue to drink partly to prevent or improve symptoms of withdrawal.<ref name=DSM5/> After a person stops drinking alcohol, they may experience a low level of withdrawal lasting for months.<ref name=DSM5/> Medically, alcoholism is considered both a physical and mental illness.<ref>{{cite journal|last1=Mersy|first1=DJ|title=Recognition of alcohol and substance abuse|journal=American Family Physician|date=1 April 2003|volume=67|issue=7|pages=1529–32|pmid=12722853}}</ref><ref>{{cite web|title=Health and Ethics Policies of the AMA House of Delegates|page=33|url=http://www.ama-assn.org/ad-com/polfind/Hlth-Ethics.pdf|accessdate=10 May 2015|date=June 2008|quote=H-30.997 Dual Disease Classification of Alcoholism: The AMA reaffirms its policy endorsing the dual classification of alcoholism under both the psychiatric and medical sections of the International Classification of Diseases. (Res. 22, I-79; Reaffirmed: CLRPD Rep. B, I-89; Reaffirmed: CLRPD Rep. B, I-90; Reaffirmed by CSA Rep. 14, A-97; Reaffirmed: CSAPH Rep. 3, A-07)|url-status=live|archiveurl=https://web.archive.org/web/20150320143132/http://www.ama-assn.org/ad-com/polfind/Hlth-Ethics.pdf|archivedate=20 March 2015}}</ref> Questionnaires and certain [[blood test]]s may detect possible alcoholism.<ref name=DSM5/><ref>{{Cite journal|last1=Higgins-Biddle|first1=John C.|last2=Babor|first2=Thomas F.|date=2018|title=A Review of the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, and USAUDIT for Screening in the United States: Past Issues and Future Directions|journal=The American Journal of Drug and Alcohol Abuse|volume=44|issue=6|pages=578–586|doi=10.1080/00952990.2018.1456545|issn=0095-2990|pmc=6217805|pmid=29723083}}</ref> Further information is then collected to confirm the diagnosis.<ref name=DSM5>{{cite book|last1=Association|first1=American Psychiatric|title=Diagnostic and statistical manual of mental disorders : DSM-5|date=2013|publisher=American Psychiatric Association|location=Washington, DC|isbn=978-0-89042-554-1|pages=[https://archive.org/details/diagnosticstatis0005unse/page/490 490–97]|edition=5|url=https://archive.org/details/diagnosticstatis0005unse/page/490}}</ref>
 
<!-- Prevention and treatment -->
Prevention of alcoholism may be attempted by regulating and limiting the sale of alcohol, [[alcohol tax|taxing alcohol]] to increase its cost, and providing inexpensive treatment.<ref>{{cite web|author=World Health Organization|title=Alcohol|url=http://www.who.int/mediacentre/factsheets/fs349/en/|accessdate=10 May 2015|date=January 2015|url-status=live|archiveurl=https://web.archive.org/web/20150523020339/http://www.who.int/mediacentre/factsheets/fs349/en/|archivedate=23 May 2015}}</ref> Treatment of alcoholism may take several forms.<ref name="Blondell-2005"/> Due to medical problems that can occur during withdrawal, [[alcohol detoxification]] should be carefully controlled.<ref name="Blondell-2005"/> One common method involves the use of [[benzodiazepine]] medications, such as [[diazepam]].<ref name="Blondell-2005"/> These can be either given while admitted to a health care institution or occasionally while a person remains in the community with close supervision.<ref name="Blondell-2005">{{cite journal | last= Blondell |first=RD | title = Ambulatory detoxification of patients with alcohol dependence | journal = Am Fam Physician | volume = 71 | issue = 3 | pages = 495–502 | date = February 2005 | pmid = 15712624 }}</ref> Mental illness or other [[addiction]]s may complicate treatment.<ref>{{cite journal|last1=DeVido|first1=JJ|last2=Weiss|first2=RD|title=Treatment of the depressed alcoholic patient|journal=Current Psychiatry Reports|date=December 2012|volume=14|issue=6|pages=610–08|pmid=22907336|doi=10.1007/s11920-012-0314-7|pmc=3712746}}</ref> After detoxification, [[group therapy]] or [[support group]]s are used to help keep a person from returning to drinking.<ref name="Morgan-Lopez-2006">{{cite journal |last1=Morgan-Lopez |first1=AA |last2=Fals-Stewart |first2=W | title = Analytic complexities associated with group therapy in substance abuse treatment research: problems, recommendations, and future directions | journal = Exp Clin Psychopharmacol | volume = 14 | issue = 2 | pages = 265–73 | date = May 2006 | pmid = 16756430 | doi = 10.1037/1064-1297.14.2.265 | pmc = 4631029 }}</ref><ref>{{cite journal|last1=Albanese|first1=AP|title=Management of alcohol abuse|journal=Clinics in Liver Disease|date=November 2012|volume=16|issue=4|pages=737–62|pmid=23101980|doi=10.1016/j.cld.2012.08.006}}</ref> One commonly used form of support is the group [[Alcoholics Anonymous]].<ref>{{cite journal|last1=Tusa|first1=AL|last2=Burgholzer|first2=JA|title=Came to believe: spirituality as a mechanism of change in alcoholics anonymous: a review of the literature from 1992 to 2012|journal=Journal of Addictions Nursing|date=2013|volume=24|issue=4|pages=237–46|pmid=24335771|doi=10.1097/jan.0000000000000003}}</ref> The medications [[acamprosate]], [[disulfiram]] or [[naltrexone]] may also be used to help prevent further drinking.<ref name=Test2014>{{cite journal|last1=Testino|first1=G|last2=Leone|first2=S|last3=Borro|first3=P|title=Treatment of alcohol dependence: recent progress and reduction of consumption|journal=Minerva Medica|date=December 2014|volume=105|issue=6|pages=447–66|pmid=25392958}}</ref>
 
<!-- Epidemiology, society and culture -->
The [[World Health Organization]] has estimated that as of 2010, there were 208&nbsp;million people with alcoholism worldwide (4.1% of the population over 15 years of age).<ref name=WHO2014/><ref name=Pew2015>{{cite web|title=Global Population Estimates by Age, 1950–2050|url=http://www.pewglobal.org/2014/01/30/global-population/|accessdate=10 May 2015|url-status=live|archiveurl=https://web.archive.org/web/20150510001645/http://www.pewglobal.org/2014/01/30/global-population/|archivedate=10 May 2015|date=30 January 2014}}</ref> As of 2015 in the United States, about 17&nbsp;million (7%) of adults and 0.7&nbsp;million (2.8%) of those age 12 to 17 years of age are affected.<ref name=NIH2015Stats>{{cite web|title=Alcohol Facts and Statistics|url=http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics|accessdate=9 May 2015|url-status=live|archiveurl=https://web.archive.org/web/20150518081638/http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics|archivedate=18 May 2015}}</ref> Alcoholism is most common among males and young adults, and is less common in middle and old age.<ref name=DSM5/> Geographically, it is least common in Africa (1.1% of the population) and has the highest rates in [[Eastern Europe]] (11%).<ref name=DSM5/> Alcoholism directly resulted in 139,000 deaths in 2013, up from 112,000 deaths in 1990.<ref name="GDB2013">{{cite journal|last1=GBD 2013 Mortality and Causes of Death|first1=Collaborators|title=Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013|journal=Lancet|date=17 December 2014|pmid=25530442|doi=10.1016/S0140-6736(14)61682-2|volume=385|issue=9963|pages=117–71|pmc=4340604}}</ref> A total of 3.3&nbsp;million deaths (5.9% of all deaths) are believed to be due to alcohol.<ref name=NIH2015Stats/> Alcoholism reduces a person's [[life expectancy]] by approximately ten years.<ref name=Schu2014>{{cite journal|last1=Schuckit|first1=MA|title=Recognition and management of withdrawal delirium (delirium tremens)|journal=The New England Journal of Medicine|date=27 November 2014|volume=371|issue=22|pages=2109–13|pmid=25427113|doi=10.1056/NEJMra1407298|url=http://www.escholarship.org/uc/item/08b9z9th}}</ref> Many terms, some [[Pejorative|insulting]] and others [[slang|informal]], have been used to refer to people affected by alcoholism; the expressions include ''tippler'', ''drunkard'', ''[[dipsomaniac]]'' and ''souse''.<ref>{{cite book|title=Chambers English Thesaurus|publisher=Allied Publishers|isbn=978-81-86062-04-3|page=175|url=https://books.google.com/books?id=IamKT5uk5lMC&pg=PA175}}</ref> In 1979, the World Health Organization discouraged the use of "alcoholism" due to its inexact meaning, preferring "alcohol dependence syndrome".<ref name="ladtpwho">{{Cite web |url=http://www.who.int/substance_abuse/terminology/who_lexicon/en/ |title=Lexicon of alcohol and drug terms published by the World Health Organization |author=WHO |publisher=World Health Organization |url-status=live |archiveurl=https://web.archive.org/web/20130205230313/http://www.who.int/substance_abuse/terminology/who_lexicon/en/ |archivedate=5 February 2013 }}</ref>
{{TOC limit}}
 
==Signs and symptoms==
[[File:What Alcohol Does to Your Body.webm|thumb|upright=1.6|Effects of alcohol on the body]]
 
The risk of alcohol dependence begins at low levels of drinking and increases directly with both the volume of alcohol consumed and a pattern of [[Binge drinking|drinking larger amounts on an occasion]], to the point of intoxication, which is sometimes called "binge drinking".
 
===Long-term misuse===
[[File:Possible long-term effects of ethanol.svg|thumb|upright=1.6|Some of the possible [[long-term effects of ethanol]] an individual may develop. Additionally, in pregnant women, alcohol can cause [[fetal alcohol syndrome]].]]
Alcoholism is characterised by an increased [[Alcohol tolerance|tolerance]] to alcohol&nbsp;– which means that an individual can consume more alcohol&nbsp;– and [[physical dependence]] on alcohol, which makes it hard for an individual to control their consumption. The physical dependency caused by alcohol can lead to an affected individual having a very strong urge to drink alcohol. These characteristics play a role in decreasing an alcoholic's ability to stop drinking.<ref name="Hoffman-1996">{{cite journal |last1=Hoffman |first1=PL |last2=Tabakoff |first2=B | title = Alcohol dependence: a commentary on mechanisms | journal = Alcohol and Alcoholism | volume = 31 | issue = 4 | pages = 333–40 | date = July 1996 | pmid = 8879279 | doi = 10.1093/oxfordjournals.alcalc.a008159 | doi-access = free }}</ref> Alcoholism can have adverse effects on mental health, contributing to psychiatric disorders and increasing the risk of suicide. A [[Depression (mood)|depressed mood]] is a common symptom of heavy alcohol drinkers.<ref>{{cite journal |last1=Dunn |first1=N |last2=Cook |first2=CC | title = Psychiatric aspects of alcohol misuse | journal = Hospital Medicine | volume = 60 | issue = 3 | pages = 169–72 | date = March 1999 | pmid = 10476237 | issn = 1462-3935 | doi=10.12968/hosp.1999.60.3.1060}}</ref><ref name="drug_abuse_prevention_a03">{{Cite book |last1=Wilson |first1=Richard |last2=Kolander |first2=Cheryl A. |title=Drug abuse prevention: a school and community partnership |year=2003 |publisher=Jones and Bartlett |location=Sudbury, MA |url={{google books |plainurl=y |id=Cm1MfcBSucUC}} |isbn=978-0-7637-1461-1 |pages=40–45}}</ref>
 
=== Warning signs ===
Warning signs of alcoholism include the consumption of increasing amounts of alcohol and frequent intoxication, preoccupation with drinking to the exclusion of other activities, promises to quit drinking and failure to keep those promises, the inability to remember what was said or done while drinking (colloquially known as "blackouts"), personality changes associated with drinking, denial or the making of excuses for drinking, the refusal to admit excessive drinking, dysfunction or other problems at work or school, the loss of interest in personal appearance or hygiene, marital and economic problems, and the complaint of poor health, with loss of appetite, respiratory infections, or increased anxiety.<ref>{{cite book|title=The Volume Library|publisher=The Southwestern Company|chapter-url={{google books |plainurl=y |id=RE9OwGtvDMACf}}|year=2009|isbn=978-0-87197-208-8|volume=1|location=Nashville, TN |page=29|chapter=Biology}}</ref>
 
====Physical====
=====Short-term effects=====
{{Main|Short-term effects of alcohol consumption}}
 
Drinking enough to cause a [[blood alcohol concentration]] (BAC) of 0.03–0.12% typically causes an overall improvement in mood and possible [[euphoria]] (a "happy" feeling), increased self-confidence and sociability, decreased anxiety, a [[Alcohol flush reaction|flushed, red appearance in the face]] and impaired judgment and fine muscle coordination. A BAC of 0.09% to 0.25% causes [[lethargy]], [[sedation]], balance problems and blurred vision. A BAC of 0.18% to 0.30% causes profound confusion, impaired speech (e.g. slurred speech), staggering, dizziness and vomiting. A BAC from 0.25% to 0.40% causes [[stupor]], unconsciousness, [[anterograde amnesia]], vomiting (death may occur due to inhalation of vomit ([[pulmonary aspiration]]) while unconscious) and [[respiratory depression]] (potentially life-threatening). A BAC from 0.35% to 0.80% causes a [[coma]] (unconsciousness), life-threatening respiratory depression and possibly fatal [[alcohol poisoning]]. With all alcoholic beverages, [[drinking and driving|drinking while driving]], operating an aircraft or heavy machinery increases the risk of an accident; many countries have penalties for drunk driving.
 
=====Long-term effects=====
{{See also|Long-term effects of alcohol consumption}}
 
Having more than one drink a day for women or two drinks for men increases the risk of heart disease, [[high blood pressure]], [[atrial fibrillation]], and [[stroke]].<ref name=Kee2014>{{cite journal |last1=O'Keefe|first1=JH|last2=Bhatti|first2=SK|last3=Bajwa|first3=A|last4=DiNicolantonio|first4=JJ|last5=Lavie|first5=CJ|title=Alcohol and cardiovascular health: the dose makes the poison&nbsp;... or the remedy|journal=Mayo Clinic Proceedings|date=March 2014|volume=89|issue=3|pages=382–93|pmid=24582196|doi=10.1016/j.mayocp.2013.11.005|doi-access=free}}</ref> Risk is greater in younger people due to [[binge drinking]], which may result in violence or accidents.<ref name=Kee2014 /> About 3.3&nbsp;million deaths (5.9% of all deaths) are believed to be due to alcohol each year.<ref name="NIH2015Stats" /> Alcoholism reduces a person's life expectancy by around ten years<ref name="Schu2014" /> and alcohol use is the third leading cause of early death in the United States.<ref name=Kee2014 /> No professional medical association recommends that people who are nondrinkers should start drinking.<ref name=Kee2014 /><ref>[http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/Alcohol-and-Heart-Health_UCM_305173_Article.jsp ''Alcohol and Heart Health''] {{webarchive|url=https://web.archive.org/web/20160119121521/http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/Alcohol-and-Heart-Health_UCM_305173_Article.jsp |date=19 January 2016 }} American Heart Association</ref> Long-term alcohol abuse can cause a number of physical symptoms, including [[cirrhosis]] of the liver, [[pancreatitis]], [[epilepsy]], [[polyneuropathy]], [[Wernicke-Korsakoff syndrome|alcoholic dementia]], heart disease, nutritional deficiencies, [[Duodenal ulcer|peptic ulcers]]<ref>{{cite book |last=American Medical Association |title=Complete Medical Encyclopedia|url={{google books |plainurl=y |id=WGURAQAAMAAJ}} |year=2003|publisher=Random House Reference |location=New York |isbn=978-0-8129-9100-0|edition=First |authorlink=Duodenal Ulcer |editor=Leiken, Jerrold B. MD |editor2=Lipsky, Martin S. MD |page=485 }}</ref> and [[sexual dysfunction]], and can eventually be fatal. Other physical effects include an increased risk of developing [[cardiovascular disease]], [[malabsorption]], [[alcoholic liver disease]], and several [[cancer]]s. Damage to the [[central nervous system]] and [[peripheral nervous system]] can occur from sustained alcohol consumption.<ref>{{cite journal |last1=Müller |first1=D |last2=Koch |first2=RD |last3=von Specht |first3=H |last4=Völker |first4=W |last5=Münch |first5=EM | title = [Neurophysiologic findings in chronic alcohol abuse] | language = German | journal = Psychiatr Neurol Med Psychol (Leipz) | volume = 37 | issue = 3 | pages = 129–32 | date = March 1985 | pmid = 2988001 }}</ref><ref>{{cite journal | last= Testino |first=G. | title = Alcoholic Diseases in Hepato-Gastroenterology: a point of view | journal = Hepatogastroenterology | volume = 55 | issue = 82–83 | pages = 371–77 | year = 2008 | pmid = 18613369 }}</ref> A wide range of immunologic defects can result and there may be a generalized skeletal fragility, in addition to a recognized tendency to accidental injury, resulting a propensity to bone fractures.<ref>[http://pubs.niaaa.nih.gov/publications/10report/intro.pdf 10th Special Report to the U.S. Congress on Alcohol and Health] {{webarchive|url=https://web.archive.org/web/20120913074727/http://pubs.niaaa.nih.gov/publications/10report/intro.pdf |date=13 September 2012 }}, 2000, U.S. Department of Health and Human Services, Public Health Service National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism.</ref>
 
Women develop long-term complications of alcohol dependence more rapidly than do men. Additionally, women have a higher mortality rate from alcoholism than men.<ref name="Blume Laura N., Nielson Nancy H., Riggs Joseph A., et all 1998 861–870"/> Examples of long-term complications include brain, heart, and liver damage<ref name="Walter H., Gutierrez K., Ramskogler K., Hertling I., Dvorak A., Lesch O.M., et al. 2003 253–268" /> and an [[alcohol and breast cancer|increased risk of breast cancer]]. Additionally, heavy drinking over time has been found to have a negative effect on reproductive functioning in women. This results in reproductive dysfunction such as [[anovulation]], decreased ovarian mass, problems or irregularity of the [[menstrual cycle]], and early [[menopause]].<ref name="Blume Laura N., Nielson Nancy H., Riggs Joseph A., et all 1998 861–870" /> Alcoholic [[ketoacidosis]] can occur in individuals who chronically abuse alcohol and have a recent history of [[binge drinking]].<ref name="Mihai-">{{cite journal |last1=Mihai |first1=B |last2=Lăcătuşu |first2=C |last3=Graur |first3=M | title = [Alcoholic ketoacidosis] | journal = Rev Med Chir Soc Med Nat Iasi | volume = 112 | issue = 2 | pages = 321–26 | date = April–June 2008 | pmid = 19294998 }}</ref><ref name="Sibaï-2005">{{cite journal |last1=Sibaï |first1=K |last2=Eggimann|first2= P | title = [Alcoholic ketoacidosis: not rare cause of metabolic acidosis] | journal = Rev Med Suisse | volume = 1 | issue = 32 | pages = 2106, 2108–10, 2112–15 | date = September 2005 | pmid = 16238232 }}</ref> The amount of alcohol that can be biologically processed and its effects differ between sexes. Equal dosages of alcohol consumed by men and women generally result in women having higher [[blood alcohol concentration]]s (BACs), since women generally have a higher percentage of body fat and therefore a lower volume of distribution for alcohol than men, and because the stomachs of men tend to metabolize alcohol more quickly.<ref name="pmid23101976">{{cite journal | last = Cederbaum |first=AI | title = Alcohol metabolism | journal = Clin Liver Dis | volume = 16 | issue = 4 | pages = 667–85 | year = 2012 | pmid = 23101976 | pmc = 3484320 | doi = 10.1016/j.cld.2012.08.002 | url = }}</ref>
 
====Psychiatric====
Long-term misuse of alcohol can cause a wide range of [[mental health]] problems. Severe [[cognitive]] problems are common; approximately 10 percent of all dementia cases are related to alcohol consumption, making it the second leading cause of [[dementia]].<ref name="aamaibnc">{{Cite web |url=http://www.eurekalert.org/pub_releases/2008-07/econ-ma070808.php |title=Alcoholism-associated molecular adaptations in brain neurocognitive circuits |first=Georgy |last=Bakalkin |date=8 July 2008 |website=Eurekalert.org |accessdate=11 January 2012 |url-status=live |archiveurl=https://web.archive.org/web/20111130152434/http://www.eurekalert.org/pub_releases/2008-07/econ-ma070808.php |archivedate=30 November 2011 }}</ref> Excessive alcohol use causes [[Brain damage|damage to brain function]], and psychological health can be increasingly affected over time.<ref>{{cite journal |last1=Oscar-Berman |first1=M |last2=Marinkovic |first2=K | title = Alcoholism and the brain: an overview | journal = Alcohol Res Health | volume = 27 | issue = 2 | pages = 125–33 | year = 2003 | pmid = 15303622 |pmc=6668884 }}</ref> [[Social skills]] are significantly impaired in people suffering from alcoholism due to the neurotoxic effects of alcohol on the brain, especially the [[prefrontal cortex]] area of the brain. The social skills that are impaired by [[alcohol abuse]] include impairments in perceiving facial emotions, [[Prosody (linguistics)|prosody]] perception problems and [[theory of mind]] deficits; the ability to understand humour is also impaired in alcohol abusers.<ref name="pmid18412750">{{cite journal |last1=Uekermann |first1=J |last2=Daum |first2=I | title = Social cognition in alcoholism: a link to prefrontal cortex dysfunction? | journal = Addiction | volume = 103 | issue = 5 | pages = 726–35 | date = May 2008 | pmid = 18412750 | doi = 10.1111/j.1360-0443.2008.02157.x | url = }}</ref> Psychiatric disorders are common in alcoholics, with as many as 25 percent suffering severe psychiatric disturbances. The most prevalent psychiatric symptoms are [[anxiety disorder|anxiety]] and [[Major depressive disorder|depression]] disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued abstinence.<ref>{{cite journal | last1 = Wetterling |first1=T |last2=Junghanns |first2=K | title = Psychopathology of alcoholics during withdrawal and early abstinence | journal = Eur Psychiatry | volume = 15 | issue = 8 | pages = 483–88 | date = September 2000 | pmid = 11175926 | doi = 10.1016/S0924-9338(00)00519-8 | issn = 0924-9338 }}</ref> [[Psychosis]], [[confusion]], and [[organic brain syndrome]] may be caused by alcohol misuse, which can lead to a misdiagnosis such as [[schizophrenia]].<ref>{{cite journal | last= Schuckit |first=MA | title = Alcoholism and other psychiatric disorders | journal = Hosp Community Psychiatry | volume = 34 | issue = 11 | pages = 1022–27 | date = November 1983 | pmid = 6642446 | issn = 0022-1597 | doi=10.1176/ps.34.11.1022}}</ref> [[Panic disorder]] can develop or worsen as a direct result of long-term alcohol misuse.<ref>{{cite journal | last= Cowley |first=DS | title = Alcohol abuse, substance abuse, and panic disorder | journal = Am J Med | volume = 92 | issue = 1A | pages = 41S–48S | date = 24 January 1992 | pmid = 1346485 | doi = 10.1016/0002-9343(92)90136-Y | issn = 0002-9343 }}</ref><ref>{{cite journal |last1=Cosci |first1=F |last2=Schruers |first2=KR |last3=Abrams |first3=K |last4=Griez |first4=EJ | title = Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship | journal = J Clin Psychiatry | volume = 68 | issue = 6 | pages = 874–80 | date = June 2007 | pmid = 17592911 | doi = 10.4088/JCP.v68n0608 | issn = 0160-6689}}</ref>
 
The co-occurrence of [[major depressive disorder]] and alcoholism is well documented.<ref>{{cite journal |last1=Grant |first1=BF |last2=Harford |first2=TC | title = Comorbidity between DSM-IV alcohol use disorders and major depression: results of a national survey | journal = Drug Alcohol Depend | volume = 39 | issue = 3 | pages = 197–206 | date = October 1995 | pmid = 8556968 | doi = 10.1016/0376-8716(95)01160-4 | issn = 0376-8716 |url=https://zenodo.org/record/1258497 }}</ref><ref>{{cite journal |last1=Kandel |first1=DB |last2=Huang |first2=FY |last3=Davies |first3=M |author-link1=Denise Kandel | title = Comorbidity between patterns of substance use dependence and psychiatric syndromes | journal = Drug Alcohol Depend | volume = 64 | issue = 2 | pages = 233–41 | date = October 2001 | pmid = 11543993 | doi = 10.1016/S0376-8716(01)00126-0 | url = | issn = 0376-8716 }}</ref><ref>{{Cite book | last1 = Cornelius | first1 = JR | last2 = Bukstein | first2 = O | last3 = Salloum | first3 = I | last4 = Clark | first4 = D | title = Alcohol and psychiatric comorbidity | journal = Recent Dev Alcohol | volume = 16 | issue = | pages = [https://archive.org/details/recentdevelopment00gala/page/361 361–74] | year = 2003 | pmid = 12638646 | doi = 10.1007/0-306-47939-7_24 | url = https://archive.org/details/recentdevelopment00gala/page/361 | isbn = 978-0-306-47258-9 | type = | issn = 0738-422X | series = Recent Developments in Alcoholism }}</ref> Among those with [[comorbid]] occurrences, a distinction is commonly made between depressive episodes that remit with alcohol abstinence ("substance-induced"), and depressive episodes that are primary and do not remit with abstinence ("independent" episodes).<ref>{{cite journal |last1=Schuckit |first1=MA |last2=Tipp |first2=JE |last3=Bergman |first3=M |last4=Reich |first4=W |last5=Hesselbrock |first5=VM |last6=Smith |first6=TL | title = Comparison of induced and independent major depressive disorders in 2,945 alcoholics | journal = Am J Psychiatry | volume = 154 | issue = 7 | pages = 948–57 | date = July 1997 | pmid = 9210745 | doi = 10.1176/ajp.154.7.948| issn = 0002-953X |doi-access=free }}</ref><ref>{{cite journal |last1=Schuckit |first1=MA |last2=Tipp |first2=JE |last3=Bucholz |first3=KK |last4=Nurnberger |first4=JI |last5=Hesselbrock |first5=VM |last6=Crowe |first6=RR |last7=Kramer |first7=J |s2cid=14958283 | title = The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls | journal = Addiction | volume = 92 | issue = 10 | pages = 1289–304 | date = October 1997 | pmid = 9489046 | doi = 10.1111/j.1360-0443.1997.tb02848.x | issn = 0965-2140 }}</ref><ref>{{cite journal |last1=Schuckit |first1=MA |last2=Smith |first2=TL |last3=Danko |first3=GP |last4=Pierson |first4=J |last5=Trim |first5=R |last6=Nurnberger |first6=JI |last7=Kramer |first7=J |last8=Kuperman |first8=S |last9=Bierut |first9=LJ |last10=Hesselbrock |first10=V |s2cid=17528609 | title = A comparison of factors associated with substance-induced versus independent depressions | journal = J Stud Alcohol Drugs | volume = 68 | issue = 6 | pages = 805–12 | date = November 2007 | pmid = 17960298 | doi = 10.15288/jsad.2007.68.805| issn = 1937-1888 }}</ref> Additional use of other drugs may increase the risk of depression.<ref>{{cite journal | last= Schuckit |first=M | title = Alcoholic patients with secondary depression | journal = Am J Psychiatry | volume = 140 | issue = 6 | pages = 711–14 | date = June 1983 | pmid = 6846629 | doi = 10.1176/ajp.140.6.711| issn = 0002-953X }}</ref> Psychiatric disorders differ depending on gender. Women who have alcohol-use disorders often have a co-occurring psychiatric diagnosis such as [[major depression]], [[anxiety]], [[panic disorder]], [[bulimia]], [[post-traumatic stress disorder]] (PTSD), or [[borderline personality disorder]]. Men with alcohol-use disorders more often have a co-occurring diagnosis of [[narcissistic personality disorder|narcissistic]] or [[antisocial personality disorder]], [[bipolar disorder]], [[schizophrenia]], [[impulse disorder]]s or [[attention deficit/hyperactivity disorder]] (ADHD).<ref name="Karrol Brad R. 2002 337–356">{{Cite journal|last1=Karrol |first1=Brad R. |title=Women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners |journal=Journal of Social Work |volume=2 |issue=3 |pages=337–56 |year=2002 |doi=10.1177/146801730200200305 }}</ref> Women with alcoholism are more likely to experience physical or [[sexual assault]], abuse and [[domestic violence]] than women in the general population,<ref name="Karrol Brad R. 2002 337–356" /> which can lead to higher instances of psychiatric disorders and greater dependence on alcohol.
 
====Social effects====
{{See also|Drug-related crime}}
 
Serious social problems arise from alcoholism; these dilemmas are caused by the pathological changes in the brain and the intoxicating effects of alcohol.<ref name="aamaibnc"/><ref name="Jessica Kingsley Publishers"/> Alcohol abuse is associated with an increased risk of committing criminal offences, including [[child abuse]], [[domestic violence]], [[rape]], [[burglary]] and [[assault]].<ref name="drug_use_a_reference_handbook">{{Cite book| last1 = Isralowitz | first1 = Richard | title = Drug use: a reference handbook | url = {{google books |plainurl=y |id=X0mxxfbIbp4C}} | year = 2004 | publisher = ABC-CLIO | location = Santa Barbara, CA | isbn = 978-1-57607-708-5 | pages = 122–23}}</ref> Alcoholism is associated with [[termination of employment|loss of employment]],<ref>{{Cite book| last1 = Langdana | first1 = Farrokh K. | title = Macroeconomic Policy: Demystifying Monetary and Fiscal Policy | url = {{google books |plainurl=y |id=GCYWQn79JYwC}} | year=2009 | publisher = Springer | edition = 2nd | isbn = 978-0-387-77665-1 | page = 81 }}</ref> which can lead to financial problems. Drinking at inappropriate times and behavior caused by reduced judgment can lead to legal consequences, such as criminal charges for [[drunk driving]]<ref name="abd2009">{{Cite book| last1 = Gifford | first1 = Maria | title = Alcoholism (Biographies of Disease) | year=2009 | publisher = Greenwood Press | url = {{google books |plainurl=y |id=2OJV12astRUC|page=89}} | isbn = 978-0-313-35908-8 | pages = 89–91 }}</ref> or public disorder, or civil penalties for [[tort]]ious behavior, and may lead to a criminal sentence. An alcoholic's behavior and mental impairment while drunk can profoundly affect those surrounding him and lead to isolation from family and friends. This isolation can lead to [[relational disorder|marital conflict]] and [[divorce]], or contribute to [[domestic violence]]. Alcoholism can also lead to [[child neglect]], with subsequent lasting damage to the emotional development of the alcoholic's children.<ref name="tcemh2006">{{Cite book |last1=Schadé |first1=Johannes Petrus |title=The Complete Encyclopedia of Medicine and Health |year=2006 |publisher=Foreign Media Books |url={{google books |plainurl=y |id=j8DuEHxSCU4C|page=132}} |isbn=978-1-60136-001-4 |pages=132–33 }}</ref> For this reason, children of alcoholic parents can develop a number of emotional problems. For example, they can become afraid of their parents, because of their unstable mood behaviors. In addition, they can develop considerable amount of shame over their inadequacy to liberate their parents from alcoholism. As a result of this failure, they develop wretched self-images, which can lead to depression.<ref>{{cite web |last=Gold |first=Mark |title=Children of Alcoholics |url=http://psychcentral.com/lib/2006/children-of-alcoholics/ |publisher=Psych Central |accessdate=27 November 2011 |url-status=live |archiveurl=https://web.archive.org/web/20111116010950/http://psychcentral.com/lib/2006/children-of-alcoholics/ |archivedate=16 November 2011 }}</ref>
 
===Alcohol withdrawal===
{{Main|Alcohol withdrawal syndrome}}
{{See also|Kindling (sedative-hypnotic withdrawal)}}
[[File:A wife asking her drunkard husband to hand over a bottle Wellcome L0067935.jpg|thumb|A French [[temperance movement|temperance]] poster from the Union des Françaises contre l'Alcool (this translates as "Union of French Women Against Alcohol"). The poster states "Ah! Quand supprimera-t'on l'alcool?", which translates as "Ah! When will we [the nation] abolish alcohol?"]]
 
As with similar substances with a sedative-hypnotic mechanism, such as [[barbiturates]] and [[benzodiazepines]], withdrawal from alcohol dependence can be fatal if it is not properly managed.<ref name="Jessica Kingsley Publishers"/><ref>{{Cite book|last1=Galanter |first1=Marc |last2=Kleber |first2=Herbert D. |title=The American Psychiatric Publishing Textbook of Substance Abuse Treatment |url={{google books |plainurl=y |id=6wdJgejlQzYC|page=58}} |edition=4th |year=2008 |publisher=American Psychiatric Publishing Inc |location= |isbn=978-1-58562-276-4 |page=58 |chapter= |chapterurl= }}</ref> Alcohol's primary effect is the increase in stimulation of the [[GABAA receptor|GABA<sub>A</sub> receptor]], promoting [[central nervous system]] depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in [[drug tolerance|tolerance]] and [[physical dependence]]. When alcohol consumption is stopped too abruptly, the person's nervous system suffers from uncontrolled [[synapse]] firing. This can result in symptoms that include [[anxiety (mood)|anxiety]], life-threatening [[seizure]]s, [[delirium tremens]], hallucinations, shakes and possible [[heart failure]].<ref name="Medical toxicology">{{Cite book|last1=Dart |first1=Richard C. |title=Medical Toxicology |url={{google books |plainurl=y |id=qDf3AO8nILoC|page=139}} |edition=3rd |year=2003 |publisher=Lippincott Williams & Wilkins |location= |isbn=978-0-7817-2845-4 |pages=139–40}}</ref><ref>{{cite journal |last1=Idemudia |first1=SO |last2=Bhadra |first2=S |last3=Lal |first3=H | title = The pentylenetetrazol-like interoceptive stimulus produced by ethanol withdrawal is potentiated by bicuculline and picrotoxinin | journal = Neuropsychopharmacology | volume = 2 | issue = 2 | pages = 115–22 | date = June 1989 | pmid = 2742726 | doi = 10.1016/0893-133X(89)90014-6 | url = | type = | issn = 0893-133X }}</ref> Other neurotransmitter systems are also involved, especially [[dopamine]], [[NMDA]] and [[glutamate]].<ref name="Hoffman-1996"/><ref>{{cite journal | last1= Chastain |first1=G | title = Alcohol, neurotransmitter systems, and behavior | journal = The Journal of General Psychology | volume = 133 | issue = 4 | pages = 329–35 | date = October 2006 | pmid = 17128954 | doi = 10.3200/GENP.133.4.329-335 | issn = 0022-1309 }}</ref>
 
Severe acute withdrawal symptoms such as [[delirium tremens]] and seizures rarely occur after 1-week post cessation of alcohol. The acute withdrawal phase can be defined as lasting between one and three weeks. In the period of 3–6 weeks following cessation increased anxiety, depression, as well as sleep disturbance, is common;<ref name="pmid20148778">{{cite journal |last1=Heilig |first1=M |last2=Egli |first2=M |last3=Crabbe |first3=JC |last4=Becker |first4=HC | title = Acute withdrawal, protracted abstinence and negative affect in alcoholism: are they linked? | journal = Addict Biol | volume = 15 | issue = 2 | pages = 169–84 | date = April 2010 | pmid = 20148778 | pmc = 3268458 | doi = 10.1111/j.1369-1600.2009.00194.x }}</ref> fatigue and tension can persist for up to 5 weeks as part of the [[post-acute withdrawal syndrome]]; about a quarter of alcoholics experience anxiety and depression for up to 2 years. These post-acute withdrawal symptoms have also been demonstrated in animal models of alcohol dependence and withdrawal.<ref>{{Cite book | last1 = Johnson | first1 = Bankole A. | title = Addiction medicine : science and practice | url = {{google books |plainurl=y |id=zvbr4Zn9S9MC|page=342}} | year = 2011 | publisher = Springer | location = New York | isbn = 978-1-4419-0337-2 | pages = 301–03 | url-status = live | archiveurl = https://web.archive.org/web/20151201092622/https://books.google.com/books?id=zvbr4Zn9S9MC&pg=PA342 | archivedate = 1 December 2015 | df = dmy-all }}</ref>
 
A [[Kindling (sedative-hypnotic withdrawal)|kindling effect]] also occurs in alcoholics whereby each subsequent withdrawal syndrome is more severe than the previous withdrawal episode; this is due to neuroadaptations which occur as a result of periods of abstinence followed by re-exposure to alcohol. Individuals who have had multiple withdrawal episodes are more likely to develop seizures and experience more severe anxiety during withdrawal from alcohol than alcohol-dependent individuals without a history of past alcohol withdrawal episodes. The kindling effect leads to persistent functional changes in brain neural circuits as well as to [[gene expression]].<ref name="Breese-2011">{{cite journal |last1=Breese |first1=GR |last2=Sinha |first2=R |last3=Heilig |first3=M | title = Chronic alcohol neuroadaptation and stress contribute to susceptibility for alcohol craving and relapse | journal = Pharmacol Ther | volume = 129 | issue = 2 | pages = 149–71 | date = February 2011 | pmid = 20951730 | pmc = 3026093 | doi = 10.1016/j.pharmthera.2010.09.007 }}</ref> Kindling also results in the intensification of psychological symptoms of alcohol withdrawal.<ref name="pmid20148778" /> There are decision tools and questionnaires which help guide physicians in evaluating alcohol withdrawal. For example, the CIWA-Ar objectifies alcohol withdrawal symptoms in order to guide therapy decisions which allows for an efficient interview while at the same time retaining clinical usefulness, validity, and reliability, ensuring proper care for withdrawal patients, who can be in danger of death.<ref>{{cite journal | last1 = Sullivan |first1=JT |last2=Sykora |first2=K |last3=Schneiderman |first3=J |last4=Naranjo |first4=CA |last5=Sellers |first5=EM | title = Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar) | journal = Br J Addict | volume = 84 | issue = 11 | pages = 1353–57 | date = November 1989 | pmid = 2597811 | doi = 10.1111/j.1360-0443.1989.tb00737.x | url = http://www.medicine.nevada.edu/residency/lasvegas/internalmed/documents/CIWA-ARBJA.pdf | access-date = 25 October 2017 | archive-url = https://web.archive.org/web/20130810022242/http://www.medicine.nevada.edu/residency/lasvegas/internalmed/documents/ciwa-arbja.pdf | archive-date = 10 August 2013 | url-status = dead | df = dmy-all |citeseerx=10.1.1.489.341 }}</ref>
 
==Causes==
[[File:William Hogarth - Gin Lane.jpg|thumb|[[William Hogarth]]'s ''[[Gin Lane]]'', 1751]]
A complex mixture of genetic and environmental factors influences the risk of the development of alcoholism.<ref name="Enoch-2006">{{cite journal | last1= Enoch |first1=MA | title = Genetic and environmental influences on the development of alcoholism: resilience vs. risk | journal = Annals of the New York Academy of Sciences | volume = 1094 | pages = 193–201 | date = December 2006 | pmid = 17347351 | doi = 10.1196/annals.1376.019 | issue=1| bibcode = 2006NYASA1094..193E |url=https://zenodo.org/record/1235882 }}</ref> Genes that influence the metabolism of alcohol also influence the risk of alcoholism, as can a family history of alcoholism.<ref name="Edenberg 2281–2297">{{Cite journal|last1=Edenberg|first1=Howard J.|last2=McClintick|first2=Jeanette N.|date=11 November 2018|title=Alcohol Dehydrogenases, Aldehyde Dehydrogenases, and Alcohol Use Disorders: A Critical Review|journal=Alcoholism: Clinical and Experimental Research|volume=42|issue=12|pages=2281–2297|doi=10.1111/acer.13904|pmid=30320893|pmc=6286250|issn=0145-6008}}</ref><ref>{{cite journal |last1=Bierut |first1=LJ |last2=Schuckit |first2=MA |last3=Hesselbrock |first3=V |last4=Reich |first4=T | title = Co-occurring risk factors for alcohol dependence and habitual smoking | journal = Alcohol Res Health | volume = 24 | issue = 4 | pages = 233–41 | year = 2000 | pmid = 15986718 |pmc=6709743 }}</ref> One paper has found that alcohol use at an early age may influence the [[gene expression|expression of genes]] which increase the risk of alcohol dependence.<ref>{{cite journal |last1=Agrawal |first1=A |last2=Sartor |first2=CE |last3=Lynskey |first3=MT |last4=Grant |first4=JD |last5=Pergadia |first5=ML |last6=Grucza |first6=R |last7=Bucholz |first7=KK |last8=Nelson |first8=EC |last9=Madden |first9=PA |last10=Martin |first10=NG |last11=Heath|first11=AC | title = Evidence for an Interaction Between Age at 1st Drink and Genetic Influences on DSM-IV Alcohol Dependence Symptoms | journal = Alcoholism: Clinical and Experimental Research | volume = 33 | issue = 12 | pages = 2047–56 | year = 2009 | pmid = 19764935 | pmc = 2883563 | doi = 10.1111/j.1530-0277.2009.01044.x }}</ref> Individuals who have a genetic disposition to alcoholism are also more likely to begin drinking at an earlier age than average.<ref name="eattrfad">{{cite news |url=http://www.medicalnewstoday.com/articles/164576.php |title=Early Age At First Drink May Modify Tween/Teen Risk For Alcohol Dependence |date=21 September 2009 |work=Medical News Today |url-status=live |archiveurl=https://web.archive.org/web/20100213100208/http://www.medicalnewstoday.com/articles/164576.php |archivedate=13 February 2010 }}</ref> Also, a younger age of onset of drinking is associated with an increased risk of the development of alcoholism,<ref name="eattrfad"/> and about 40 percent of alcoholics will drink excessively by their late adolescence. It is not entirely clear whether this association is causal, and some researchers have been known to disagree with this view.<ref name="Schwandt-2010">{{cite journal |last1=Schwandt |first1=ML |last2=Lindell |first2=SG |last3=Chen |first3=S |last4=Higley |first4=JD |last5=Suomi |first5=SJ |last6=Heilig |first6=M |last7=Barr |first7=CS | title = Alcohol Response and Consumption in Adolescent Rhesus Macaques: Life History and Genetic Influences | journal = Alcohol | volume = 44 | issue = 1 | pages = 67–80 | date = February 2010 | pmid = 20113875 | pmc = 2818103 | doi = 10.1016/j.alcohol.2009.09.034 }}</ref>
 
[[Psychological trauma|Severe childhood trauma]] is also associated with a general increase in the risk of drug dependency.<ref name="Enoch-2006"/> Lack of peer and family support is associated with an increased risk of alcoholism developing.<ref name="Enoch-2006"/> Genetics and adolescence are associated with an increased sensitivity to the neurotoxic effects of chronic alcohol abuse. [[Cerebral cortex|Cortical]] degeneration due to the neurotoxic effects increases impulsive behaviour, which may contribute to the development, persistence and severity of alcohol use disorders. There is evidence that with abstinence, there is a reversal of at least some of the alcohol induced central nervous system damage.<ref name="Crews-2009">{{cite journal |last1=Crews |first1=FT |last2=Boettiger |first2=CA | title = Impulsivity, Frontal Lobes and Risk for Addiction | journal = Pharmacol Biochem Behav | volume = 93 | issue = 3 | pages = 237–47 | date = September 2009 | pmid = 19410598 | pmc = 2730661 | doi = 10.1016/j.pbb.2009.04.018 }}</ref> The use of cannabis was associated with later problems with alcohol use.<ref name="PMID26875671">{{cite journal|pmid=26875671|pmc=5028105|year=2016|last1=Weinberger|first1=A.H.|title=Is cannabis use associated with an increased risk of onset and persistence of alcohol use disorders? A three-year prospective study among adults in the United States|journal=Drug and Alcohol Dependence|volume=161|pages=363–67|last2=Platt|first2=J|last3=Goodwin|first3=R.D.|doi=10.1016/j.drugalcdep.2016.01.014}}</ref> Alcohol use was associated with an increased probability of later use of tobacco and illegal drugs such as cannabis.<ref name="PMID22712674">{{cite journal|pmid=22712674|url=http://www.mamacultiva.org/wp-content/uploads/2015/pdf/A8%20-%20Alcohol%20as%20a%20Gateway%20Drug%20A%20Study%20of%20US%2012th%20Graders.pdf|year=2012|last1=Kirby|first1=T|title=Alcohol as a gateway drug: A study of US 12th graders|journal=Journal of School Health|volume=82|issue=8|pages=371–79|last2=Barry|first2=A.E.|doi=10.1111/j.1746-1561.2012.00712.x|url-status=live|archiveurl=https://web.archive.org/web/20160604012851/http://www.mamacultiva.org/wp-content/uploads/2015/pdf/A8%20-%20Alcohol%20as%20a%20Gateway%20Drug%20A%20Study%20of%20US%2012th%20Graders.pdf|archivedate=4 June 2016}}</ref>
 
===Availability===
Alcohol is the most available, widely consumed, and widely abused [[recreational drug]]. [[Beer]] alone is the world's most widely consumed<ref>{{cite web|title=Volume of World Beer Production|website=European Beer Guide|url=http://www.europeanbeerguide.net/eustats.htm#production|accessdate=17 October 2006| archiveurl= https://web.archive.org/web/20061028165040/http://www.europeanbeerguide.net/eustats.htm| archivedate= 28 October 2006 | url-status= live}}</ref> [[alcoholic beverage]]; it is the third-most popular drink overall, after [[Drinking water|water]] and [[tea]].<ref name="Nelson 2005">{{Cite book|url={{google books |plainurl=y |id=6xul0O_SI1MC|page=1}}|title=The Barbarian's Beverage: A History of Beer in Ancient Europe|year=2005|publisher=Routledge|location=Abingdon, Oxon|isbn=978-0-415-31121-2|page=1|accessdate=21 September 2010|last= Nelson|first=Max}}</ref> It is thought by some to be the oldest fermented beverage.<ref>{{cite book|title=The Alchemy of Culture: Intoxicants in Society|first=Richard|last=Rudgley|isbn=978-0-7141-1736-2|year=1993|pages=411|url={{google books |plainurl=y |id=5baAAAAAMAAJ}}|publisher=British Museum Press|location=London|accessdate=13 January 2012}}</ref><ref>{{cite book|title=Origin and History of Beer and Brewing: From Prehistoric Times to the Beginning of Brewing Science and Technology|first=John P|last=Arnold|isbn=978-0-9662084-1-2|year=2005|page=411|url={{google books |plainurl=y |id=O5CPAAAACAAJ}}|location=Cleveland, OH|accessdate=13 January 2012}}</ref><ref>Joshua J. Mark (2011). [http://www.ancient.eu.com/Beer/ Beer] {{webarchive|url=https://web.archive.org/web/20140703005835/http://www.ancient.eu.com/Beer/ |date=3 July 2014 }}. Ancient History Encyclopedia.</ref><ref>{{Cite book|first1=Ben|last1= McFarland|url={{google books |plainurl=y |id=SHh-4M_QxEsC|page=10}}|title=World's Best Beers: One Thousand |publisher=Sterling Publishing Company, Inc.|isbn=978-1-4027-6694-7 |year=2009 }}</ref>
 
===Gender difference===
Based on combined data from [[Substance Abuse and Mental Health Services Administration|SAMHSA]]'s 2004–2005 National Surveys on Drug Use & Health, the rate of past-year alcohol dependence or abuse among persons aged 12 or older varied by level of alcohol use: 44.7% of past month heavy drinkers, 18.5% binge drinkers, 3.8% past month non-binge drinkers, and 1.3% of those who did not drink alcohol in the past month met the criteria for alcohol dependence or abuse in the past year. Males had higher rates than females for all measures of drinking in the past month: any alcohol use (57.5% vs. 45%), binge drinking (30.8% vs. 15.1%), and heavy alcohol use (10.5% vs. 3.3%), and males were twice as likely as females to have met the criteria for alcohol dependence or abuse in the past year (10.5% vs. 5.1%).<ref>"Gender differences in alcohol use and alcohol dependence or abuse: 2004 or 2005." The NSDUH Report. Accessed 22 June 2012.</ref>
 
===Genetic variation===
{{See also|Addiction#Genetic factors}}
There are genetic variations that affect the risk for alcoholism.<ref name="Edenberg 2281–2297" /><ref name="Enoch-2006" /><ref name=":1" /><ref name=":2">{{Cite journal|last1=Kranzler|first1=Henry R.|last2=Zhou|first2=Hang|last3=Kember|first3=Rachel L.|last4=Vickers Smith|first4=Rachel|last5=Justice|first5=Amy C.|last6=Damrauer|first6=Scott|last7=Tsao|first7=Philip S.|last8=Klarin|first8=Derek|last9=Baras|first9=Aris|last10=Reid|first10=Jeffrey|last11=Overton|first11=John|date=2 April 2019|title=Genome-wide association study of alcohol consumption and use disorder in 274,424 individuals from multiple populations|journal=Nature Communications|volume=10|issue=1|pages=1499|doi=10.1038/s41467-019-09480-8|issn=2041-1723|pmc=6445072|pmid=30940813|bibcode=2019NatCo..10.1499K}}</ref> Some of these variations are more common in individuals with ancestry from certain areas, for example Africa, East Asia, the Middle East and Europe. The variants with strongest effect are in genes that encode the main enzymes of alcohol metabolism, ADH1B and ALDH2.<ref name="Edenberg 2281–2297" /><ref name=":1" /><ref name=":2" /> These genetic factors influence the rate at which alcohol and its initial metabolic product, acetaldehyde, are metabolized.<ref name="Edenberg 2281–2297" /> They are found at different frequencies in people from different parts of the world.<ref name="Eng-2007">{{cite journal |last1=Eng |first1=MY |last2=Luczak |first2=SE |last3=Wall |first3=TL | title = ALDH2, ADH1B, and ADH1C genotypes in Asians: a literature review | journal = Alcohol Res Health | volume = 30 | issue = 1 | pages = 22–27 | year = 2007 | pmid = 17718397 | pmc = 3860439 }}</ref><ref name="Edenberg 2281–2297"/><ref name="Ehlers-2007">{{cite journal|last=Ehlers|first=CL|year=2007|title=Variations in ADH and ALDH in Southwest California Indians|journal=Alcohol Res Health|volume=30|issue=1|pages=14–17|pmc=3860438|pmid=17718395}}</ref> The [[alcohol dehydrogenase]] allele ADH1B*2 causes a more rapid metabolism of alcohol to acetaldehyde, and reduces risk for alcoholism;<ref name="Edenberg 2281–2297" /> it is most common in individuals from East Asia and the Middle East. The [[alcohol dehydrogenase]] allele ADH1B*3 causes a more rapid metabolism of alcohol. The allele ADH1B*3 is only found in some individuals of African descent and certain Native American tribes. African Americans and Native Americans with this allele have a reduced risk of developing alcoholism.<ref name="Edenberg 2281–2297" /><ref name="Ehlers-2007" /><ref name="Scott-2007">{{cite journal |last1=Scott |first1=DM |last2=Taylor |first2=RE | title = Health-related effects of genetic variations of alcohol-metabolizing enzymes in African Americans | journal = Alcohol Res Health | volume = 30 | issue = 1 | pages = 18–21 | year = 2007 | pmid = 17718396 | doi = | pmc = 3860436 }}</ref> [[Indigenous peoples of the Americas|Native Americans]], however, have a significantly higher rate of alcoholism than average; risk factors such as cultural environmental effects e.g. [[psychological trauma|trauma]] have been proposed to explain the higher rates.<ref name="Szlemko-2006">{{cite journal |last1=Szlemko |first1=WJ |last2=Wood |first2=JW |last3=Thurman |first3=PJ | title = Native Americans and alcohol: past, present, and future | journal = J Gen Psychol | volume = 133 | issue = 4 | pages = 435–51 | date = October 2006 | pmid = 17128961 | doi = 10.3200/GENP.133.4.435-451 }}</ref><ref name="Spillane-2007">{{cite journal |last1=Spillane |first1=NS |last2=Smith |first2=GT | title = A theory of reservation-dwelling American Indian alcohol use risk | journal = Psychol Bull | volume = 133 | issue = 3 | pages = 395–418 | date = May 2007 | pmid = 17469984 | doi = 10.1037/0033-2909.133.3.395 }}</ref> The [[aldehyde dehydrogenase]] allele ALDH2*2 greatly reduces the rate at which acetaldehyde, the initial product of alcohol metabolism, is removed by conversion to acetate; it greatly reduces the risk for alcoholism.<ref name="Edenberg 2281–2297" /><ref name="Eng-2007" />
 
A [[genome-wide association study]] of more than 100,000 human individuals identified variants of the gene ''KLB'', which encodes the [[transmembrane protein]] β-[[Klotho (biology)|Klotho]], as highly associated with alcohol consumption. The protein β-Klotho is an essential element in [[cell surface receptor]]s for [[hormone]]s involved in modulation of appetites for [[Monosaccharide|simple sugars]] and alcohol.<ref>{{cite journal|last1=Schumann|first1=G |s2cid=4060021 |display-authors=et al|title=KLB is associated with alcohol drinking, and its gene product β-Klotho is necessary for FGF21 regulation of alcohol preference|journal=PNAS USA|date=2016|volume=113|issue=50|pages=14372–77|doi=10.1073/pnas.1611243113|pmid=27911795|pmc=5167198}}</ref> A GWAS has found differences in the genetics of alcohol consumption and alcohol dependence, although the two are to some degree related.<ref name=":1">{{Cite journal|last1=Walters|first1=Raymond K.|last2=Polimanti|first2=Renato|last3=Johnson|first3=Emma C.|last4=McClintick|first4=Jeanette N.|last5=Adams|first5=Mark J.|last6=Adkins|first6=Amy E.|last7=Aliev|first7=Fazil|last8=Bacanu|first8=Silviu-Alin|last9=Batzler|first9=Anthony|last10=Bertelsen|first10=Sarah|last11=Biernacka|first11=Joanna M.|date=2018|title=Trans-ancestral GWAS of alcohol dependence reveals common genetic underpinnings with psychiatric disorders|journal=Nature Neuroscience|volume=21|issue=12|pages=1656–1669|doi=10.1038/s41593-018-0275-1|issn=1097-6256|pmc=6430207|pmid=30482948}}</ref>
 
==Diagnosis==
{{See also|Addiction medicine}}
 
===Definition===
[[File:Emil Mayer 024.jpg|thumb|A man drinking from a bottle of liquor while sitting on a boardwalk, ca. 1905–1914. Picture by Austrian photographer [[Emil Mayer]].]]
Misuse, problem use, abuse, and heavy use of alcohol refer to improper use of alcohol, which may cause physical, social, or moral harm to the drinker.<ref name="the_american_heritage_dictionary_of_the_english_language_a12">{{Cite book| author= American Heritage Dictionaries | title = The American Heritage dictionary of the English language | url = {{google books |plainurl=y |id=uPCFIQAACAAJ}} | year=2006 |publisher = Houghton Mifflin | location = Boston | edition = 4 |quote = To use wrongly or improperly; misuse: abuse alcohol | isbn = 978-0-618-70172-8 }}</ref> ''The Dietary Guidelines for Americans'' defines "moderate use" as no more than two alcoholic beverages a day for men and no more than one alcoholic beverage a day for women.<ref>{{Cite web |url=http://www.health.gov/DIETARYGUIDELINES/dga2005/document/html/chapter9.htm |title=Dietary Guidelines for Americans 2005 |year=2005 |publisher=health.gov |url-status=dead |archiveurl=https://web.archive.org/web/20070701174135/http://www.health.gov/DIETARYGUIDELINES/dga2005/document/html/chapter9.htm |archivedate=1 July 2007 |access-date=28 November 2009 }} Dietary Guidelines</ref> Some drinkers may drink more than 600 ml of alcohol per day during a heavy drinking period.<ref>See question 16 of the [[Severity of Alcohol Dependence Questionnaire]].</ref> The [[National Institute on Alcohol Abuse and Alcoholism]] (NIAAA) defines [[binge drinking]] as the amount of alcohol leading to a blood alcohol content (BAC) of 0.08, which, for most adults, would be reached by consuming five drinks for men or four for women over a two-hour period. According to the NIAAA, men may be at risk for alcohol-related problems if their alcohol consumption exceeds 14 [[standard drink]]s per week or 4 drinks per day, and women may be at risk if they have more than 7 standard drinks per week or 3 drinks per day. It defines a standard drink as one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5&nbsp;ounces of distilled spirits.<ref>{{Cite journal |date=April 2006 |title=Young Adult Drinking |url=http://pubs.niaaa.nih.gov/publications/aa68/aa68.htm |url-status=live |journal=Alcohol Alert |archive-url=https://web.archive.org/web/20130213205702/http://pubs.niaaa.nih.gov/publications/aa68/aa68.htm |archive-date=13 February 2013 |access-date=18 February 2013 |number=68}}</ref> Despite this risk, a 2014 report in the National Survey on Drug Use and Health found that only 10% of either "heavy drinkers" or "binge drinkers" defined according to the above criteria also met the criteria for alcohol dependence, while only 1.3% of non-binge drinkers met the criteria. An inference drawn from this study is that evidence-based policy strategies and clinical preventive services may effectively reduce binge drinking without requiring addiction treatment in most cases.<ref name="Esser2014">{{cite journal|last1=Esser|first1=Marissa B.|last2=Hedden|first2=Sarra L.|last3=Kanny|first3=Dafna|last4=Brewer|first4=Robert D.|last5=Gfroerer|first5=Joseph C.|last6=Naimi|first6=Timothy S.|title=Prevalence of Alcohol Dependence Among US Adult Drinkers, 2009–2011|journal=Preventing Chronic Disease|date=20 November 2014|volume=11|page=E206|doi=10.5888/pcd11.140329|pmid=25412029|pmc=4241371}}</ref>
 
====Alcoholism====
The term ''alcoholism'' is commonly used amongst laypeople, but the word is poorly defined. The WHO calls ''alcoholism'' "a term of long-standing use and variable meaning", and use of the term was disfavored by a 1979 WHO expert committee. ''[[The Big Book (Alcoholics Anonymous)|The Big Book]]'' (from [[Alcoholics Anonymous]]) states that once a person is an alcoholic, they are always an alcoholic (but others note that many do recover), but does not define what is meant by the term ''alcoholic'' in this context. In 1960, [[Bill W.]], co-founder of Alcoholics Anonymous (AA), said:
:We have never called alcoholism a [[disease]] because, technically speaking, it is not a disease entity. For example, there is no such thing as [[heart disease]]. Instead there are many separate heart ailments, or combinations of them. It is something like that with alcoholism. We did not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. We always called it an [[illness]], or a [[malady]]&nbsp;– a far safer term for us to use.<ref name="McGovernWhite2003">{{Cite book|first1=Thomas F.|last1= McGovern|first2=William L. |last2=White|title=Alcohol Problems in the United States: Twenty Years of Treatment Perspective|url={{google books |plainurl=y |id=3gRwmYohuooC|page=7}}|accessdate=17 April 2010|year=2003|publisher=Routledge|isbn=978-0-7890-2049-9|pages=7–}}</ref>
 
In professional and research contexts, the term "alcoholism" sometimes encompasses both alcohol abuse and alcohol dependence,<ref>{{DorlandsDict|one/000002709|alcoholism}}</ref> and sometimes is considered equivalent to alcohol dependence. Talbot (1989) observes that alcoholism in the classical disease model follows a progressive course: if a person continues to drink, their condition will worsen. This will lead to harmful consequences in their life, physically, mentally, emotionally and socially.<ref name=Thomb1999>{{cite book|last=Thombs|first=Dennis L|title=Introduction To Addictive Behaviors 2ed|url={{google books |plainurl=y |id=Aze4azm9XkQCIntroduction}}|year=1999|publisher=The Guildford Press|location=London|pages=64–65}}</ref> Johnson (1980) explores the emotional progression of the addict's response to alcohol. He looks at this in four phases. The first two are considered "normal" drinking and the last two are viewed as "typical" alcoholic drinking.<ref name=Thomb1999/> Johnson's four phases consist of:
# Learning the mood swing. A person is introduced to alcohol (in some cultures this can happen at a relatively young age), and the person enjoys the happy feeling it produces. At this stage, there is no emotional cost.
# Seeking the mood swing. A person will drink to regain that feeling of euphoria experienced in phase 1; the drinking will increase as more intoxication is required to achieve the same effect. Again at this stage, there are no significant consequences.
# At the third stage there are physical and social consequences, i.e., hangovers, family problems, work problems, etc. A person will continue to drink excessively, disregarding the problems.
# The fourth stage can be detrimental, as Johnson cites it as a risk for premature death. As a person now drinks to feel normal, they block out the feelings of overwhelming guilt, remorse, anxiety, and shame they experience when sober.<ref name=Thomb1999/>
 
====Milam & Ketcham's physical deterioration stages====
Other theorists such as Milam & Ketcham (1983) focus on the physical deterioration that alcohol consumption causes. They describe the process in three stages:
# Adaptive stage – The person will not experience any negative symptoms, and they believe they have the capacity for drinking alcohol without problems. Physiological changes are happening with the increase in tolerance, but this will not be noticeable to the drinker or others.
# Dependent stage – At this stage, symptoms build up gradually. [[Hangover]] symptoms from excessive drinking may be confused with withdrawal symptoms. Many addicts will maintain their drinking to avoid withdrawal sickness, drinking small amounts frequently. They will try to hide their drinking problem from others and will avoid gross intoxication.
# Deterioration stage – Various organs are damaged due to long-term drinking. Medical treatment in a rehabilitation center will be required; otherwise, the pathological changes will cause death.
 
====DSM and ICD====
In psychology and psychiatry, the DSM is the most common global standard, while in medicine, the standard is ICD. The terms they recommend are similar but not identical.
 
{| class="wikitable"
|-
! Organization
! Preferred term(s)
! Definition
|-
| [[American Psychiatric Association|APA]]'s [[Diagnostic and Statistical Manual of Mental Disorders|DSM-IV]]
| "[[alcohol abuse]]" and "[[alcohol dependence]]"
|
* alcohol abuse = repeated use despite recurrent adverse consequences.<ref name="the_apa_dictionary_of_psychology">{{Cite book| last1 = VandenBos | first1 = Gary R. | title = APA dictionary of psychology | url = {{google books |plainurl=y |id=OSoZAQAAIAAJ}} | year = 2006 |publisher = American Psychological Association | location = Washington, DC | isbn = 978-1-59147-380-0 }}</ref>
* alcohol dependence = ''alcohol abuse'' combined with [[Drug tolerance|tolerance]], [[Drug withdrawal|withdrawal]], and an uncontrollable drive to drink.<ref name="the_apa_dictionary_of_psychology"/> The term "alcoholism" was split into "alcohol abuse" and "alcohol dependence" in 1980's DSM-III, and in 1987's DSM-III-R behavioral symptoms were moved from "abuse" to "dependence".<ref name="urlDiagnostic Criteria for Alcohol Abuse and Dependence – Alcohol Alert No. 30-1995">{{Cite web|url=http://pubs.niaaa.nih.gov/publications/aa30.htm |title=Diagnostic Criteria for Alcohol Abuse and Dependence – Alcohol Alert No. 30-1995 |accessdate=17 April 2010| archiveurl= https://web.archive.org/web/20100327051827/http://pubs.niaaa.nih.gov/publications/aa30.htm| archivedate= 27 March 2010 | url-status= live}}</ref> It has been suggested that [[DSM-V]] merge alcohol abuse and alcohol dependence into a single new entry,<ref name="pmid18729609">{{cite journal |last1=Martin |first1=CS |last2=Chung |first2=T |last3=Langenbucher |first3=JW | title = How Should We Revise Diagnostic Criteria for Substance Use Disorders in the DSM–V? | journal = J Abnorm Psychol | volume = 117 | issue = 3 | pages = 561–75 | date = August 2008 | pmid = 18729609 | pmc = 2701140 | doi = 10.1037/0021-843X.117.3.561 }}</ref> named "alcohol-use disorder".<ref name="urlProposed Revision | APA DSM-5">{{Cite web|url=http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=452# |title=Proposed Revision &#124; APA DSM-5 |accessdate=17 April 2010| archiveurl= https://web.archive.org/web/20100325235023/http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=452| archivedate= 25 March 2010 | url-status= live}}</ref>
|-
| [[World Health Organization|WHO]]'s [[ICD-10]]
| "alcohol harmful use" and "alcohol dependence syndrome"
| Definitions are similar to that of the DSM-IV. The World Health Organization uses the term "alcohol dependence syndrome" rather than alcoholism.<ref name="ladtpwho"/> The concept of "harmful use" (as opposed to "abuse") was introduced in 1992's ICD-10 to minimize underreporting of damage in the absence of dependence.<ref name="urlDiagnostic Criteria for Alcohol Abuse and Dependence – Alcohol Alert No. 30-1995"/> The term "alcoholism" was removed from ICD between ICD-8/ICDA-8 and [[ICD-9]].<ref name="urlA System to Convert ICD Diagnostic Codes for Alcohol Research">{{Cite web |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/00000324.htm |title=A System to Convert ICD Diagnostic Codes for Alcohol Research |accessdate=17 April 2010 |url-status=live |archiveurl=https://web.archive.org/web/20090424013232/http://www.cdc.gov/mmwr/preview/mmwrhtml/00000324.htm |archivedate=24 April 2009 }}</ref>
|}
 
The [[DSM-IV]] diagnosis of alcohol dependence represents one approach to the definition of alcoholism. In part, this is to assist in the development of research protocols in which findings can be compared to one another. According to the DSM-IV, an alcohol dependence diagnosis is: "maladaptive alcohol use with clinically significant impairment as manifested by at least three of the following within any one-year period: tolerance; withdrawal; taken in greater amounts or over longer time course than intended; desire or unsuccessful attempts to cut down or control use; great deal of time spent obtaining, using, or recovering from use; social, occupational, or recreational activities given up or reduced; continued use despite knowledge of physical or psychological [[sequela]]e."<ref name="DSMIV">{{Cite book| title = Diagnostic and statistical manual of mental disorders: DSM-IV | url = {{google books |plainurl=y |id=W-BGAAAAMAAJ}} |year = 1994 | publisher = American Psychiatric Association | location = Washington, DC | isbn = 978-0-89042-025-6 | pages = }}</ref> Despite the imprecision inherent in the term, there have been attempts to define how the word ''alcoholism'' should be interpreted when encountered. In 1992, it was defined by the [[National Council on Alcoholism and Drug Dependence]] (NCADD) and [[American Society of Addiction Medicine|ASAM]] as "a primary, chronic disease characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking."<ref>{{cite journal |last1=Morse |first1=RM |last2=Flavin |first2=DK | title = The definition of alcoholism. The Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism | journal = JAMA: The Journal of the American Medical Association | volume = 268 | issue = 8 | pages = 1012–14 | date = August 1992 | pmid = 1501306 | doi = 10.1001/jama.1992.03490080086030 | url = | type = | issn = 0098-7484 }}</ref> [[MeSH]] has had an entry for "alcoholism" since 1999, and references the 1992 definition.<ref>{{MeshName|Alcoholism}}</ref>
 
AA describes alcoholism as an illness that involves a physical allergy<ref name="AABigBook">{{Cite book | authorlink = Alcoholics Anonymous | author= The first 100 members of AA | title = Alcoholics Anonymous: the story of how many thousands of men and women have recovered from alcoholism |url={{google books |plainurl=y |id=uufjAQAACAAJ}}| publisher = Alcoholics Anonymous World Services | origyear = 1939 | year = 2001 | location = New York | pages = xxxii, 575 | isbn = 978-1-893007-16-1 | nopp = true | url-status = live | archiveurl = https://web.archive.org/web/20170430230542/http://www.aa.org/ | archivedate = 30 April 2017 | df = dmy-all }}</ref>{{Rp|28}} (where "allergy" has a different meaning than that used in modern medicine.<ref>{{cite journal | last= Kay |first=AB | title = Overview of 'allergy and allergic diseases: with a view to the future' | journal = Br. Med. Bull. | volume = 56 | issue = 4 | pages = 843–64 | year = 2000 | pmid = 11359624 | doi = 10.1258/0007142001903481 | issn = 0007-1420 | doi-access = free }}</ref>) and a mental obsession.<ref name="AABigBook" />{{Rp|23}}<ref>{{Cite web|title=The Big Book Self Test |url=http://www.intoaction.us/SelfTest.html |publisher=intoaction.us |accessdate=19 February 2008 |url-status=dead |archiveurl=https://web.archive.org/web/20071123101711/http://www.intoaction.us/SelfTest.html |archivedate=23 November 2007 }}</ref> The doctor and addiction specialist [[William Duncan Silkworth|Dr. William D. Silkworth M.D.]] writes on behalf of AA that "Alcoholics suffer from a "(physical) craving beyond mental control".<ref name="AABigBook" />{{Rp|xxvi}} A 1960 study by [[E. Morton Jellinek]] is considered the foundation of the modern [[disease theory of alcoholism]].<ref>{{Cite web|title=October 22 Deaths|url=http://www.todayinsci.com/10/10_22.htm|publisher=todayinsci.com|accessdate=18 February 2008| archiveurl= https://web.archive.org/web/20080207170157/http://www.todayinsci.com/10/10_22.htm| archivedate= 7 February 2008 | url-status= live}}</ref> Jellinek's definition restricted the use of the word ''alcoholism'' to those showing a particular [[natural history of disease|natural history]]. The modern medical definition of ''alcoholism'' has been revised numerous times since then. The [[American Medical Association]] uses the word alcoholism to refer to a particular chronic primary disease.<ref name="autogenerated1">{{Cite web |url=http://www.ama-assn.org/ama1/pub/upload/mm/388/sci_drug_addiction.pdf |title=Science of Addiction |first=Nora |last=Volkow |publisher=American Medical Association |url-status=live |archiveurl=https://web.archive.org/web/20110629022654/http://www.ama-assn.org/ama1/pub/upload/mm/388/sci_drug_addiction.pdf |archivedate=29 June 2011 }}</ref>
 
===Social barriers===
Attitudes and social stereotypes can create barriers to the detection and treatment of alcohol abuse. This is more of a barrier for women than men. Fear of stigmatization may lead women to deny that they are suffering from a medical condition, to hide their drinking, and to drink alone. This pattern, in turn, leads family, physicians, and others to be less likely to suspect that a woman they know is an alcoholic.<ref name="Blume Laura N., Nielson Nancy H., Riggs Joseph A., et all 1998 861–870" >{{Cite journal | last1 = Blum | first1 = Laura N. | last2 = Nielsen | first2 = Nancy H. | last3 = Riggs | first3 = Joseph A. | last4 = Council on Scientific Affairs, American Medical Association | author-link4 = American Medical Association | title = Alcoholism and alcohol abuse among women: report of the council on scientific affairs | journal = [[Journal of Women's Health]] | volume = 7 | issue = 7 | pages = 861–70 | doi = 10.1089/jwh.1998.7.861 | pmid = 9785312 | date = September 1998 | ref = harv }}</ref> In contrast, reduced fear of stigma may lead men to admit that they are suffering from a medical condition, to display their drinking publicly, and to drink in groups. This pattern, in turn, leads family, physicians, and others to be more likely to suspect that a man they know is an alcoholic.<ref name="Karrol Brad R. 2002 337–356" />
 
===Screening===
Screening is recommended among those over the age of 18.<ref>{{cite journal |last1=US Preventive Services Task |first1=Force. |last2=Curry |first2=SJ |last3=Krist |first3=AH |last4=Owens |first4=DK |last5=Barry |first5=MJ |last6=Caughey |first6=AB |last7=Davidson |first7=KW |last8=Doubeni |first8=CA |last9=Epling JW |first9=Jr |last10=Kemper |first10=AR |last11=Kubik |first11=M |last12=Landefeld |first12=CS |last13=Mangione |first13=CM |last14=Silverstein |first14=M |last15=Simon |first15=MA |last16=Tseng |first16=CW |last17=Wong |first17=JB |title=Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement. |journal=JAMA |date=13 November 2018 |volume=320 |issue=18 |pages=1899–1909 |doi=10.1001/jama.2018.16789 |pmid=30422199|doi-access=free }}</ref> Several tools may be used to detect a loss of control of alcohol use. These tools are mostly [[self report study|self-reports]] in questionnaire form. Another common theme is a score or tally that sums up the general severity of alcohol use.<ref name="Kahan-1996">{{cite journal | last= Kahan |first=M | title = Identifying and managing problem drinkers | journal = Can Fam Physician | volume = 42 | issue = | pages = 661–71 | date = April 1996 | pmid = 8653034 | pmc = 2146411 | doi = }}</ref>
 
The [[CAGE questionnaire]], named for its four questions, is one such example that may be used to screen patients quickly in a doctor's office.
 
{{Quotation|Two "yes" responses indicate that the respondent should be investigated further.
 
The questionnaire asks the following questions:
 
# Have you ever felt you needed to '''C'''ut down on your drinking?
# Have people '''A'''nnoyed you by criticizing your drinking?
# Have you ever felt '''G'''uilty about drinking?
# Have you ever felt you needed a drink first thing in the morning ('''E'''ye-opener) to steady your nerves or to get rid of a hangover?<ref>{{Cite journal|last=Ewing |first=JA |title=Detecting alcoholism. The CAGE questionnaire |journal=JAMA: The Journal of the American Medical Association |volume=252 |issue=14 |pages=1905–07 |date=October 1984 |pmid=6471323 |doi=10.1001/jama.1984.03350140051025 |url= |issn=0098-7484 |type= }}</ref><ref>{{Cite web|url=http://www.whoguidemhpcuk.org/downloads/primary_care/11-1_CAGE_questionnaire.pdf |title=CAGE questionnaire – screen for alcohol misuse |url-status=dead |archiveurl=https://web.archive.org/web/20110728175054/http://www.whoguidemhpcuk.org/downloads/primary_care/11-1_CAGE_questionnaire.pdf |archivedate=28 July 2011 }}</ref>}}
 
:The CAGE questionnaire has demonstrated a high effectiveness in detecting alcohol-related problems; however, it has limitations in people with less severe alcohol-related problems, white women and college students.<ref>{{cite journal | last1 = Dhalla |first1=S |last2=Kopec |first2=JA | title = The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies | journal = Clin Invest Med | volume = 30 | issue = 1 | pages = 33–41 | year = 2007 | pmid = 17716538 | df = dmy-all |doi=10.25011/cim.v30i1.447 | doi-access = free }}</ref>
 
Other tests are sometimes used for the detection of alcohol dependence, such as the [[Alcohol Dependence Data Questionnaire]], which is a more sensitive diagnostic test than the [[CAGE questionnaire]]. It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol use.<ref>{{Cite web |url=http://www.emcdda.europa.eu/html.cfm/index3556EN.html |title=Alcohol Dependence Data Questionnaire (SADD) |last1=Raistrick |first1=D. |last2=Dunbar|first2= G. |last3=Davidson |first3=R. |year=1983 |publisher=European Monitoring Centre for Drugs and Drug Addiction |url-status=live |archiveurl=https://web.archive.org/web/20160721101929/http://www.emcdda.europa.eu/html.cfm/index3556EN.html |archivedate=21 July 2016 }}</ref> The [[Michigan Alcohol Screening Test]] (MAST) is a screening tool for alcoholism widely used by courts to determine the appropriate sentencing for people convicted of alcohol-related offenses,<ref>{{Cite web |url=http://www.ncadd-sfv.org/symptoms/mast_test.html |title=Michigan Alcohol Screening Test |publisher=The National Council on Alcoholism and Drug Dependence |url-status=dead |archiveurl=https://web.archive.org/web/20060906123532/http://www.ncadd-sfv.org/symptoms/mast_test.html |archivedate=6 September 2006 }}</ref> [[driving under the influence]] being the most common. The [[Alcohol Use Disorders Identification Test]] (AUDIT), a screening questionnaire developed by the [[World Health Organization]], is unique in that it has been validated in six countries and is used internationally. Like the CAGE questionnaire, it uses a simple set of questions – a high score earning a deeper investigation.<ref>{{Cite web |url=http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf |title=The Alcohol Use Disorders Identification Test; Guidelines for Use in Primary Care |first1=Thomas F. |last1=Babor |first2=John C. |last2=Higgins-Biddle |first3=John B. |last3=Saunders |first4=Maristela G. |last4=Monteiro |year=2001 |publisher=World Health Organization |url-status=dead |archiveurl=https://web.archive.org/web/20060502132711/http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf |archivedate=2 May 2006 }}</ref> The [[Paddington Alcohol Test]] (PAT) was designed to screen for alcohol-related problems amongst those attending [[Accident and Emergency department]]s. It concords well with the AUDIT questionnaire but is administered in a fifth of the time.<ref>{{cite journal | last1 = Smith |first1=SG |last2=Touquet |first2=R |last3=Wright |first3=S |last4=Das Gupta |first4=N | title = Detection of alcohol misusing patients in accident and emergency departments: the Paddington alcohol test (PAT) | journal = Journal of Accident and Emergency Medicine | volume = 13 | issue = 5 | pages = 308–12 | date = September 1996 | pmid = 8894853 | pmc = 1342761 | doi = 10.1136/emj.13.5.308 | issn = 1351-0622 }}</ref> Certain blood tests may also indicate possible alcoholism.<ref name=DSM5/>
 
===Urine and blood tests===
There are reliable tests for the actual use of alcohol, one common test being that of [[blood alcohol content]] (BAC).<ref>{{cite journal | last= Jones |first=AW | title = Urine as a biological specimen for forensic analysis of alcohol and variability in the urine-to-blood relationship | journal = Toxicol Rev | volume = 25 | issue = 1 | pages = 15–35 | year = 2006 | pmid = 16856767 | doi = 10.2165/00139709-200625010-00002 }}</ref> These tests do not differentiate alcoholics from non-alcoholics; however, long-term heavy drinking does have a few recognizable effects on the body, including:<ref>{{cite journal |last1=Das |first1=SK |last2= Dhanya |first2=L |last3=Vasudevan |first3=DM | title = Biomarkers of alcoholism: an updated review | journal = Scand J Clin Lab Invest | volume = 68 | issue = 2 | pages = 81–92 | year = 2008 | pmid = 17852805 | doi = 10.1080/00365510701532662 }}</ref>
* [[Macrocytosis]] (enlarged [[Mean corpuscular volume|MCV]])
* Elevated [[Gamma glutamyl transpeptidase|GGT]]
* Moderate elevation of [[Aspartate transaminase|AST]] and [[Alanine transaminase|ALT]] and an AST: ALT ratio of 2:1
* High [[carbohydrate deficient transferrin]] (CDT)
 
With regard to alcoholism, BAC is useful to judge [[alcohol tolerance]], which in turn is a sign of alcoholism.<ref name=DSM5/> Electrolyte and acid-base abnormalities including [[hypokalemia]], [[hypomagnesemia]], [[hyponatremia]], [[hyperuricemia]], [[metabolic acidosis]], and [[respiratory alkalosis]] are common in alcoholics.<ref name="NIHHx" />
 
However, none of these blood tests for biological markers is as sensitive as screening questionnaires.
 
==Prevention==
{{further|Alcohol education}}
The [[World Health Organization]], the [[European Union]] and other regional bodies, national governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism.<ref name="alchwho2010">{{Cite web |url=http://www.who.int/topics/alcohol_drinking/en/ |title=Alcohol |author=World Health Organization |year=2010 |url-status=live |archiveurl=https://web.archive.org/web/20100226094205/http://www.who.int/topics/alcohol_drinking/en/ |archivedate=26 February 2010 }}</ref><ref name="apitwhoer">{{Cite web|url=http://www.euro.who.int/document/mediacentre/fs1005e.pdf |title=Alcohol policy in the WHO European Region: current status and the way forward |date=12 September 2005 |publisher=World Health Organization |url-status=dead |archiveurl=https://web.archive.org/web/20100123105252/http://www.euro.who.int/document/mediacentre/fs1005e.pdf |archivedate=23 January 2010 }}</ref> Targeting adolescents and young adults is regarded as an important step to reduce the harm of alcohol abuse. Increasing the age at which licit drugs of abuse such as alcohol can be purchased, the banning or restricting advertising of alcohol has been recommended as additional ways of reducing the harm of alcohol dependence and abuse. Credible, [[evidence based]] educational campaigns in the mass media about the consequences of alcohol abuse have been recommended. Guidelines for parents to prevent alcohol abuse amongst adolescents, and for helping young people with mental health problems have also been suggested.<ref name="acdacpovfa">{{cite journal |last1=Crews |first1=F |last2=He |first2=J |last3=Hodge |first3=C | title = Adolescent cortical development: a critical period of vulnerability for addiction | journal = Pharmacol Biochem Behav | volume = 86 | issue = 2 | pages = 189–99 | date = February 2007 | pmid = 17222895 | doi = 10.1016/j.pbb.2006.12.001 }}</ref>
 
==Management==
Treatments are varied because there are multiple perspectives of alcoholism. Those who approach alcoholism as a medical condition or disease recommend differing treatments from, for instance, those who approach the condition as one of social choice. Most treatments focus on helping people discontinue their alcohol intake, followed up with life training and/or social support to help them resist a return to alcohol use. Since alcoholism involves multiple factors which encourage a person to continue drinking, they must all be addressed to successfully prevent a relapse. An example of this kind of treatment is detoxification followed by a combination of supportive therapy, attendance at self-help groups, and ongoing development of coping mechanisms. The treatment community for alcoholism typically supports an abstinence-based [[zero tolerance]] approach; however, some prefer a [[Harm reduction|harm-reduction]] approach.<ref name="Gabbard"/>
 
===Detoxification===
{{Main|Alcohol detoxification}}
[[Alcohol detoxification]] or 'detox' for alcoholics is an abrupt stop of alcohol drinking coupled with the substitution of drugs, such as [[benzodiazepines]], that have similar effects to prevent [[Alcohol withdrawal syndrome|alcohol withdrawal]]. Individuals who are only at risk of mild to moderate withdrawal symptoms can be detoxified as outpatients. Individuals at risk of a severe withdrawal syndrome as well as those who have significant or acute comorbid conditions are generally treated as inpatients. Detoxification does not actually treat alcoholism, and it is necessary to follow up detoxification with an appropriate treatment program for alcohol dependence or abuse to reduce the risk of relapse.<ref name="Blondell-2005"/> Some symptoms of alcohol withdrawal such as depressed mood and anxiety typically take weeks or months to abate while other symptoms persist longer due to persisting neuroadaptations.<ref name="pmid20148778" /> Alcoholism has serious adverse effects on brain function; on average it takes one year of abstinence to recover from the cognitive deficits incurred by chronic alcohol abuse.<ref name="Stavro-2012">{{cite journal |last1=Stavro |first1=K |last2=Pelletier |first2=J |last3=Potvin |first3=S | title = Widespread and sustained cognitive deficits in alcoholism: a meta-analysis | journal = Addict Biol | volume = 18 | issue = 2 | pages = 203–13 | date = January 2012 | pmid = 22264351 | doi = 10.1111/j.1369-1600.2011.00418.x }}</ref>
 
===Psychological===
[[File:Alcoholics Anonymous Regional Service Center by David Shankbone.jpg|thumb|A regional service center for [[Alcoholics Anonymous]].]]
 
Various forms of [[group therapy]] or [[psychotherapy]] can be used to deal with underlying psychological issues that are related to alcohol addiction, as well as provide relapse prevention skills. The mutual-help group-counseling approach is one of the most common ways of helping alcoholics maintain sobriety.<ref name="Morgan-Lopez-2006"/> [[Alcoholics Anonymous]] was one of the first organizations formed to provide mutual, nonprofessional counseling, and it is still the largest. Others include [[LifeRing Secular Recovery]], [[SMART Recovery]], [[Women for Sobriety]], and [[Secular Organizations for Sobriety]].<ref>{{Cite web|url=http://www.helpguide.org/articles/addiction/self-help-groups-for-alcohol-addiction.htm|title=Self-Help Groups for Alcohol Addiction|last1=Smith, M.A.|first1=Melinda|last2=Saisan, M.S.W.|first2=Joanna|date=2016|url-status=live|archiveurl=https://web.archive.org/web/20150521163926/http://www.helpguide.org/articles/addiction/self-help-groups-for-alcohol-addiction.htm|archivedate=21 May 2015}}</ref> Alcoholics Anonymous and [[twelve-step program]]s appear more effective than cognitive behavioral therapy or abstinence.<ref name=coch2020>{{cite journal |title=Alcoholics Anonymous and other 12‐step programs for alcohol use disorder |journal=Cochrane Database of Systematic Reviews |year=2020 |doi=10.1002/14651858.CD012880.pub2 |pmid=32159228 |vauthors=Kelly JF, Humphreys K, Ferri M |volume=3 |pages=CD012880 |type=Systematic review |pmc=7065341}}</ref>
 
===Moderate drinking===
 
Rationing and moderation programs such as [[Moderation Management]] and DrinkWise do not mandate complete abstinence. While most alcoholics are unable to limit their drinking in this way, some return to moderate drinking. A 2002 US study by the [[National Institute on Alcohol Abuse and Alcoholism]] (NIAAA) showed that 17.7 percent of individuals diagnosed as alcohol dependent more than one year prior returned to low-risk drinking. This group, however, showed fewer initial symptoms of dependency.<ref name="DAWSON2005">{{cite journal | last1 = Dawson |first1=DA |last2=Grant|first2= BF |last3=Stinson |first3=FS |last4=Chou |first4=PS |last5=Huang |first5=B |last6=Ruan |first6=WJ | title = Recovery from DSM-IV alcohol dependence: United States, 2001–2002 | journal = Addiction | volume = 100 | issue = 3 | pages = 281–92 | year = 2005 | pmid = 15733237 | doi = 10.1111/j.1360-0443.2004.00964.x | url = http://pubs.niaaa.nih.gov/publications/arh29-2/131-142.htm | url-status = live | archiveurl = https://web.archive.org/web/20110719104620/http://pubs.niaaa.nih.gov/publications/arh29-2/131-142.htm | archivedate = 19 July 2011 | df = dmy-all }}</ref>
 
A follow-up study, using the same subjects that were judged to be in remission in 2001–2002, examined the rates of return to problem drinking in 2004–2005. The study found abstinence from alcohol was the most stable form of remission for recovering alcoholics.<ref name="DAWSON2007">{{cite journal |last1=Dawson |first1=DA |last2=Goldstein |first2=RB |last3=Grant |first3=BF | title = Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up | journal = Alcoholism: Clinical and Experimental Research | volume = 31 | issue = 12 | pages = 2036–45 | year = 2007 | pmid = 18034696 | doi = 10.1111/j.1530-0277.2007.00536.x |url=https://zenodo.org/record/1230663 }}</ref> There was also a 1973 study showing chronic alcoholics drinking moderately again,<ref name=Sobell1973>{{cite journal|doi=10.1016/S0005-7894(73)80074-7|title=Individualized behavior therapy for alcoholics|journal=Behavior Therapy|volume=4|pages=49–72|year=1973|last1=Sobell|first1=Mark B.|last2=Sobell|first2=Linda C.}}</ref> but a 1982 follow-up showed that 95% of subjects were not able to moderately drink over the long term.<ref name=Pendery1982>{{cite journal|doi=10.1126/science.7089552 |pmid=7089552 |title=Controlled drinking by alcoholics? New findings and a reevaluation of a major affirmative study |journal=Science |volume=217 |issue=4555 |pages=169–175 |year=1982 |last1=Pendery |first1=M. |last2=Maltzman |first2=I. |last3=West |first3=L. |bibcode=1982Sci...217..169P }}</ref><ref name=Pendery1982NYT>{{cite news|url=https://www.nytimes.com/1982/06/28/us/alcholism-study-under-new-attack.html|title=Alcoholism Study Under New Attack|work=[[The New York Times]]|date=28 June 1982|quote=The new article will say that, 10 years later, four of the 20 had died from alcohol-related causes. Eight others were still drinking excessively, six were abstinent but in most cases after multiple hospitalizations, and one was drinking moderately. The alcohol dependence of that last case was also questioned. Another subject, who could not be found, was reported gravely disabled.}}</ref> Another study was a long-term (60 year) follow-up of two groups of alcoholic men which concluded that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence."<ref name="VAILLANT2003">{{cite journal | last= Vaillant |first=GE |s2cid=12835128 | title = A 60-year follow-up of alcoholic men | journal = Addiction | volume = 98 | issue = 8 | pages = 1043–51 | year = 2003 | pmid = 12873238 | doi = 10.1046/j.1360-0443.2003.00422.x }}</ref> Internet based measures appear to be useful at least in the short term.<ref>{{cite journal |last1=Riper |first1=H |last2=Hoogendoorn |first2=A |last3=Cuijpers |first3=P |last4=Karyotaki |first4=E |last5=Boumparis |first5=N |last6=Mira |first6=A |last7=Andersson |first7=G |last8=Berman |first8=AH |last9=Bertholet |first9=N |last10=Bischof |first10=G |last11=Blankers |first11=M |last12=Boon |first12=B |last13=Boß |first13=L |last14=Brendryen |first14=H |last15=Cunningham |first15=J |last16=Ebert |first16=D |last17=Hansen |first17=A |last18=Hester |first18=R |last19=Khadjesari |first19=Z |last20=Kramer |first20=J |last21=Murray |first21=E |last22=Postel |first22=M |last23=Schulz |first23=D |last24=Sinadinovic |first24=K |last25=Suffoletto |first25=B |last26=Sundström |first26=C |last27=de Vries |first27=H |last28=Wallace |first28=P |last29=Wiers |first29=RW |last30=Smit |first30=JH |title=Effectiveness and treatment moderators of internet interventions for adult problem drinking: An individual patient data meta-analysis of 19 randomised controlled trials. |journal=PLOS Medicine |date=December 2018 |volume=15 |issue=12 |pages=e1002714 |doi=10.1371/journal.pmed.1002714 |pmid=30562347|pmc=6298657 }}</ref>
 
===Medications===
In the United States there are four approved medications for alcoholism: acamprosate, two methods of using naltrexone and disulfiram.<ref>{{Cite journal |title= Alcohol and Other Drugs|url=http://pubs.niaaa.nih.gov/publications/AA76/AA76.htm |url-status=live |publisher=National Institute on Alcohol Abuse and Alcoholism |archive-url=https://web.archive.org/web/20130728134244/http://pubs.niaaa.nih.gov/publications/aa76/aa76.htm |archive-date=28 July 2013 |access-date=11 July 2013 |number=76|date=July 2008|journal=Alcohol Alert}}</ref>
* [[Acamprosate]] may stabilise the brain chemistry that is altered due to alcohol dependence via antagonising the actions of [[glutamate]], a neurotransmitter which is hyperactive in the [[post-withdrawal]] phase.<ref>{{cite journal |last1=Mason |first1=BJ |last2=Heyser |first2=CJ | title = The neurobiology, clinical efficacy and safety of acamprosate in the treatment of alcohol dependence | journal = Expert Opin Drug Saf | volume = 9 | issue = 1 | pages = 177–88 | date = January 2010 | pmid = 20021295 | doi = 10.1517/14740330903512943 }}</ref> By reducing excessive NMDA activity which occurs at the onset of alcohol withdrawal, acamprosate can reduce or prevent alcohol withdrawal related neurotoxicity.<ref name="pmid20201812">{{cite journal |last1=Mason |first1=BJ |last2=Heyser |first2=CJ | title = Acamprosate: A prototypic neuromodulator in the treatment of alcohol dependence | journal = CNS Neurol Disord Drug Targets | volume = 9 | issue = 1 | pages = 23–32 | date = March 2010 | pmid = 20201812 | pmc = 2853976 | doi = 10.2174/187152710790966641 }}</ref> Acamprosate reduces the risk of relapse amongst alcohol-dependent persons.<ref>{{cite journal | last1 = Rösner |first1=S |last2=Hackl-Herrwerth |first2=A |last3=Leucht |first3=S |last4=Lehert |first4=P |last5=Vecchi |first5=S |last6=Soyka |first6=M | title = Acamprosate for alcohol dependence | journal = Cochrane Database of Systematic Reviews |volume=128 | issue = 9 | page = 379 | year = 2010 | pmid = 20824837 | doi = 10.1002/14651858.CD004332.pub2 | editor1-last = Rösner | editor1-first = Susanne |url=http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802010000600014 |type=Submitted manuscript }}</ref><ref name=JAMA2014>{{cite journal |last1=Jonas |first1=DE |last2=Amick |first2=HR |last3=Feltner |first3=C |last4=Bobashev |first4=G |last5=Thomas |first5=K |last6=Wines |first6=R |last7=Kim |first7=MM |last8=Shanahan |first8=E |last9=Gass |first9=CE |last10=Rowe |first10=CJ |last11=Garbutt |first11=JC | title = Pharmacotherapy for Adults With Alcohol Use Disorders in Outpatient Settings | journal = JAMA | volume = 311 | issue = 18 | pages = 1889–900 | date = 14 May 2014 | pmid = 24825644 | doi = 10.1001/jama.2014.3628 |doi-access=free }}</ref>
* [[Naltrexone]] is a [[competitive antagonist]] for opioid receptors, effectively blocking the effects of [[endorphin]]s and [[opioid]]s. Naltrexone is used to decrease cravings for alcohol and encourage abstinence. Alcohol causes the body to release endorphins, which in turn release dopamine and activate the reward pathways; hence in the body reduces the pleasurable effects from consuming alcohol.<ref>{{cite journal |last1=Soyka |first1=M |last2=Rösner |first2=S | title = Opioid antagonists for pharmacological treatment of alcohol dependence – a critical review | journal = Curr Drug Abuse Rev | volume = 1 | issue = 3 | pages = 280–91 | date = November 2008 | pmid = 19630726 | doi = 10.2174/1874473710801030280 }}</ref> Evidence supports a reduced risk of relapse among alcohol-dependent persons and a decrease in excessive drinking.<ref name=JAMA2014/> [[Nalmefene]] also appears effective and works in a similar manner.<ref name=JAMA2014/>
* {{anchor|The Sinclair Method}}The Sinclair method is another approach to using naltrexone or other [[opioid antagonist]]s to treat alcoholism by having the person take the medication about an hour before they drink alcohol ''and only then''.<ref>{{cite web|last1=Anderson|first1=Kenneth|title=Drink Your Way Sober with Naltrexone|url=https://www.psychologytoday.com/blog/overcoming-addiction/201307/drink-your-way-sober-naltrexone|website=Psychology Today|accessdate=18 July 2016|date=28 July 2013|url-status=live|archiveurl=https://archive.is/20140620140245/http://www.psychologytoday.com/blog/overcoming-addiction/201307/drink-your-way-sober-naltrexone|archivedate=20 June 2014}}</ref><ref name=Sin2001>{{cite journal|last1=Sinclair|first1=JD|title=Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism|journal=Alcohol and Alcoholism|date=2001|volume=36|issue=1|pages=2–10|pmid=11139409|doi=10.1093/alcalc/36.1.2|doi-access=free}}</ref> The medication blocks the [[positive reinforcement]] effects of ethanol and hypothetically allows the person to stop drinking or drink less.<ref name=Sin2001/>
* [[Disulfiram]] prevents the elimination of [[acetaldehyde]], a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many [[hangover]] symptoms from alcohol use. The overall effect is discomfort when alcohol is ingested: an extremely fast-acting and long-lasting, uncomfortable hangover.
 
Several other drugs are also used and many are under investigation.
* [[Benzodiazepines]], while useful in the management of acute alcohol withdrawal, if used long-term can cause a worse outcome in alcoholism. Alcoholics on chronic benzodiazepines have a lower rate of achieving abstinence from alcohol than those not taking benzodiazepines. This class of drugs is commonly prescribed to alcoholics for insomnia or anxiety management.<ref>{{Cite book|editor1-first=S.J.E. |editor1-last=Lindsay |editor2-first=Graham E. |editor2-last=Powell |title=The Handbook of Clinical Adult Psychology |url={{google books |plainurl=y |id=a6A9AAAAIAAJ|page=380}} |edition=2nd |date=28 July 1998 |publisher=Routledge |isbn=978-0-415-07215-1 |page=402 |chapter= |chapterurl= }}</ref> Initiating prescriptions of benzodiazepines or sedative-hypnotics in individuals in recovery has a high rate of relapse with one author reporting more than a quarter of people relapsed after being prescribed sedative-hypnotics. Those who are long-term users of benzodiazepines should not be withdrawn rapidly, as severe anxiety and panic may develop, which are known risk factors for relapse into alcohol abuse. Taper regimes of 6–12 months have been found to be the most successful, with reduced intensity of withdrawal.<ref>{{Cite book|last1=Gitlow |first1=Stuart |title=Substance Use Disorders: A Practical Guide |url={{google books |plainurl=y |id=rbrSdWVerBUC}} |edition=2nd |year=2006 |publisher=Lippincott Williams & Wilkins |location= |isbn=978-0-7817-6998-3 |pages=52, 103–21}}</ref><ref>{{cite journal |last1=Kushner |first1=MG |last2=Abrams |first2=K |last3=Borchardt |first3=C | title = The relationship between anxiety disorders and alcohol use disorders: a review of major perspectives and findings | journal = Clin Psychol Rev | volume = 20 | issue = 2 | pages = 149–71 | date = March 2000 | pmid = 10721495 | doi = 10.1016/S0272-7358(99)00027-6 }}</ref>
* [[Calcium carbimide]] works in the same way as disulfiram; it has an advantage in that the occasional adverse effects of disulfiram, [[hepatotoxicity]] and drowsiness, do not occur with calcium carbimide.<ref>{{cite journal | last= Ogborne |first=AC | title = Identifying and treating patients with alcohol-related problems | journal = CMAJ | volume = 162 | issue = 12 | pages = 1705–08 | date = June 2000 | pmid = 10870503 | pmc = 1232509 }}</ref>
* [[Ondansetron]] and [[topiramate]] are supported by tentative evidence in people with certain genetics.<ref name=Soy2017/><ref name=Cs2017>{{cite journal |last1=Cservenka |first1=A |last2=Yardley |first2=MM |last3=Ray |first3=LA |title=Review: Pharmacogenetics of alcoholism treatment: Implications of ethnic diversity. |journal=The American Journal on Addictions |date=August 2017 |volume=26 |issue=5 |pages=516–25 |doi=10.1111/ajad.12463 |pmid=28134463|pmc=5484746 }}</ref> Evidence for ondansetron is more in those who have just begun having problems with alcohol.<ref name=Soy2017>{{cite journal |last1=Soyka |first1=M |last2=Müller |first2=CA |title=Pharmacotherapy of alcoholism – an update on approved and off-label medications. |journal=Expert Opinion on Pharmacotherapy |date=August 2017 |volume=18 |issue=12 |pages=1187–99 |doi=10.1080/14656566.2017.1349098 |pmid=28658981}}</ref>
 
Evidence does not support the use of [[selective serotonin reuptake inhibitors]] (SSRIs), [[tricyclic antidepressants]] (TCAs), [[antipsychotic]]s, or [[gabapentin]].<ref name=JAMA2014/>
 
===Dual addictions and dependences===
Alcoholics may also require treatment for other psychotropic [[drug addiction]]s and [[drug dependence]]s. The most common dual dependence syndrome with alcohol dependence is [[benzodiazepine dependence]], with studies showing 10–20 percent of alcohol-dependent individuals had problems of dependence and/or misuse problems of benzodiazepine drugs such as [[diazepam]] or [[clonazepam]]. These drugs are, like alcohol, [[depressant]]s. Benzodiazepines may be used legally, if they are prescribed by doctors for anxiety problems or other mood disorders, or they may be purchased as [[illegal drugs]]. Benzodiazepine use increases cravings for alcohol and the volume of alcohol consumed by problem drinkers.<ref>{{cite journal |last1=Poulos |first1=CX |last2=Zack |first2=M | title = Low-dose diazepam primes motivation for alcohol and alcohol-related semantic networks in problem drinkers | journal = Behav Pharmacol | volume = 15 | issue = 7 | pages = 503–12 | date = November 2004 | pmid = 15472572 | doi = 10.1097/00008877-200411000-00006 | url = | issn = 0955-8810 }}</ref> Benzodiazepine dependency requires careful reduction in dosage to avoid [[benzodiazepine withdrawal syndrome]] and other health consequences. Dependence on other sedative-hypnotics such as [[zolpidem]] and [[zopiclone]] as well as [[opiate]]s and illegal drugs is common in alcoholics. Alcohol itself is a sedative-hypnotic and is cross-tolerant with other sedative-hypnotics such as [[barbiturate]]s, benzodiazepines and [[nonbenzodiazepine]]s. Dependence upon and withdrawal from sedative-hypnotics can be medically severe and, as with alcohol withdrawal, there is a risk of [[psychosis]] or [[seizure]]s if not properly managed.<ref name="dolpdaa">{{cite journal | last1 = Johansson |first1=BA |last2=Berglund |first2=M |last3=Hanson |first3=M |last4=Pöhlén |first4=C |last5=Persson |first5=I | title = Dependence on legal psychotropic drugs among alcoholics | journal = Alcohol and Alcoholism | volume = 38 | issue = 6 | pages = 613–18 | date = November 2003 | pmid = 14633651 | doi = 10.1093/alcalc/agg123 | url = http://alcalc.oxfordjournals.org/cgi/reprint/38/6/613 | format = PDF | issn = 0735-0414 | url-status = live | archiveurl = https://web.archive.org/web/20090220090248/http://alcalc.oxfordjournals.org/cgi/reprint/38/6/613 | archivedate = 20 February 2009 | df = dmy-all | doi-access = free }}</ref>
 
==Epidemiology==
[[File:Alcohol use disorders world map-DALYs per million persons-WHO2012.svg|thumb|upright=1.5|[[Disability-adjusted life year]] for alcohol use disorders per million&nbsp;inhabitants in 2012.
{{refbegin|3}}
{{legend|#ffff20|234-806}}
{{legend|#ffe820|814-1,501}}
{{legend|#ffd820|1,551-2,585}}
{{legend|#ffc020|2,838}}
{{legend|#ffa020|2,898-3,935}}
{{legend|#ff9a20|3,953-5,069}}
{{legend|#f08015|5,168}}
{{legend|#e06815|5,173-5,802}}
{{legend|#d85010|5,861-8,838}}
{{legend|#d02010|9,122-25,165}}
{{refend}}]]
[[File:Alcohol consumption per person, OWID.svg|thumb|upright=1.5|Alcohol consumption per person 2016.<ref>{{cite web |title=Alcohol consumption per person |url=https://ourworldindata.org/grapher/total-alcohol-consumption-per-capita-litres-of-pure-alcohol |website=Our World in Data |accessdate=5 March 2020}}</ref>]]
 
The [[World Health Organization]] estimates that as of 2010 there are 208&nbsp;million people with alcoholism worldwide (4.1% of the population over 15 years of age).<ref name=WHO2014/><ref name=Pew2015/> Substance use disorders are a major [[public health]] problem facing many countries. "The most common substance of abuse/dependence in patients presenting for treatment is alcohol."<ref name="Gabbard">{{Cite book| last1 = Gabbard | first1 = Glen O. | title = Treatments of psychiatric disorders | year = 2001 | publisher = American Psychiatric Press | location = Washington, DC | url = {{google books |plainurl=y |id=hLVrAAAAMAAJ}} |edition=3| isbn = 978-0-88048-910-2 }}</ref> In the [[United Kingdom]], the number of 'dependent drinkers' was calculated as over 2.8&nbsp;million in 2001.<ref name="cosu">{{Cite web |url=http://sia.dfc.unifi.it/costi%20uk.pdf |title=Alcohol misuse: How much does it cost? |date=September 2003 |publisher=Cabinet Office Strategy Unit |url-status=dead |archiveurl=https://web.archive.org/web/20110515020051/http://sia.dfc.unifi.it/costi%20uk.pdf |archivedate=15 May 2011 }}</ref> About 12% of American adults have had an alcohol dependence problem at some time in their life.<ref>{{cite journal |last1=Hasin |first1=DS |last2=Stinson |first2=FS |last3=Ogburn |first3=E |last4=Grant |first4=BF | title = Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Alcohol Abuse and Dependence in the United States | journal = Archives of General Psychiatry | volume = 64 | issue = 7 | pages = 830–42 | year = 2007 | pmid = 17606817 | doi = 10.1001/archpsyc.64.7.830 |doi-access=free }}</ref> In the United States and Western Europe, 10 to 20 percent of men and 5 to 10 percent of women at some point in their lives will meet criteria for alcoholism.<ref>{{cite encyclopedia |url=http://www.britannica.com/EBchecked/topic/13448/alcoholism |title=alcoholism |year=2010 |encyclopedia=Encyclopædia Britannica |url-status=live |archiveurl=https://web.archive.org/web/20101202043009/http://www.britannica.com/EBchecked/topic/13448/alcoholism |archivedate=2 December 2010 }}</ref> [[Estonia]] had the highest death rate from alcohol in Europe in 2015 at 8.8 per 100,000 population.<ref>{{cite book|last1=Ballas|first1=Dimitris|last2=Dorling|first2=Danny|last3=Hennig|first3=Benjamin|title=The Human Atlas of Europe|url={{google books |plainurl=y |id=z1ClDgAAQBAJThe}}|date=2017|publisher=Policy Press|location=Bristol|isbn=978-1-4473-1354-0|page=73|accessdate=}}</ref> In the United States, 30% of people admitted to hospital have a problem related to alcohol.<ref>{{Cite journal|last1=Vonghia|first1=Luisa|last2=Leggio|first2=Lorenzo|last3=Ferrulli|first3=Anna|last4=Bertini|first4=Marco|last5=Gasbarrini|first5=Giovanni|last6=Addolorato|first6=Giovanni|last7=Alcoholism Treatment Study Group|date=December 2008|title=Acute alcohol intoxication|journal=European Journal of Internal Medicine|volume=19|issue=8|pages=561–67|doi=10.1016/j.ejim.2007.06.033|issn=1879-0828|pmid=19046719}}</ref>
 
Within the medical and scientific communities, there is a broad consensus regarding alcoholism as a disease state. For example, the American Medical Association considers alcohol a drug and states that "drug addiction is a chronic, relapsing brain disease characterized by compulsive drug seeking and use despite often devastating consequences. It results from a complex interplay of biological vulnerability, environmental exposure, and developmental factors (e.g., stage of brain maturity)."<ref name="autogenerated1" /> Alcoholism has a higher prevalence among men, though, in recent decades, the proportion of female alcoholics has increased.<ref name="Walter H., Gutierrez K., Ramskogler K., Hertling I., Dvorak A., Lesch O.M., et al. 2003 253–268">{{cite journal |last1=Walter |first1=H|last2= Gutierrez |first2=K |last3=Ramskogler |first3=K|last4= Hertling |first4=I |last5=Dvorak |first5=A |last6=Lesch |first6=OM | title = Gender-specific differences in alcoholism: implications for treatment | journal = Archives of Women's Mental Health | volume = 6 | issue = 4 | pages = 253–58 | date = November 2003 | pmid = 14628177 | doi = 10.1007/s00737-003-0014-8 }}</ref> Current evidence indicates that in both men and women, alcoholism is 50–60 percent genetically determined, leaving 40–50 percent for environmental influences.<ref>{{cite journal |last1=Dick |first1=DM |last2=Bierut |first2=LJ | title = The genetics of alcohol dependence | journal = Current Psychiatry Reports | volume = 8 | issue = 2 | pages = 151–57 | date = April 2006 | pmid = 16539893 | doi = 10.1007/s11920-006-0015-1 | url = | issn = 1523-3812 }}</ref> Most alcoholics develop alcoholism during adolescence or young adulthood.<ref name="Enoch-2006"/> 31 percent of college students show signs of alcohol abuse, while six percent are dependent on alcohol. Under the [[Diagnostic and Statistical Manual of Mental Disorders|DSM]]'s new definition of alcoholics, that means about 37 percent of college students may meet the criteria.<ref>{{cite web|url=http://dailyemerald.com/2012/05/22/redefining-alcoholic-what-this-means-for-students/|title=About 37 percent of college students could now be considered alcoholics|website=Emerald Media|url-status=live|archiveurl=https://web.archive.org/web/20131017051524/http://dailyemerald.com/2012/05/22/redefining-alcoholic-what-this-means-for-students/|archivedate=17 October 2013}}</ref>
 
==Prognosis==
[[File:Alcohol use disorders world map-Deaths per million persons-WHO2012.svg|thumb|upright=1.3|Alcohol use disorders deaths per million persons in 2012
{{refbegin|3}}
{{legend|#ffff20|0–0}}
{{legend|#ffc020|1–3}}
{{legend|#ffa020|4–6}}
{{legend|#ff9a20|7–13}}
{{legend|#f08015|14–20}}
{{legend|#e06815|21–37}}
{{legend|#d85010|38–52}}
{{legend|#d02010|53–255}}
{{refend}}
]]
Alcoholism often reduces a person's life expectancy by around ten years.<ref name=Schu2014/> The most common cause of death in alcoholics is from cardiovascular complications.<ref name="Zuskin-2006">{{cite journal |last1=Zuskin |first1=E |last2=Jukić |first2=V |last3=Lipozencić |first3=J |last4=Matosić |first4=A |last5=Mustajbegović |first5=J |last6=Turcić |first6=N |last7=Poplasen-Orlovac |first7=D |last8=Bubas |first8=M |last9=Prohić |first9=A | title = [Alcoholism – how it affects health and working capacity] | journal = Arh Hig Rada Toksikol | volume = 57 | issue = 4 | pages = 413–26 | date = December 2006 | pmid = 17265681 | doi = }}</ref> There is a high rate of [[suicide]] in chronic alcoholics, which increases the longer a person drinks. Approximately 3–15 percent of alcoholics commit suicide,<ref>{{cite book|title=American Psychiatric Association practice guidelines for the treatment of psychiatric disorders|date=2006|publisher=American Psychiatric Association|location=Arlington, VA|isbn=978-0-89042-385-1|page=1346|url={{google books |plainurl=y |id=zql0AqtRSrYC|page=1346}}|url-status=live|archiveurl=https://web.archive.org/web/20160529103328/https://books.google.com/books?id=zql0AqtRSrYC&pg=PA1346|archivedate=29 May 2016}}</ref> and research has found that over 50 percent of all suicides are associated with alcohol or [[drug dependence]]. This is believed to be due to alcohol causing physiological distortion of brain chemistry, as well as social isolation. Suicide is also very common in adolescent alcohol abusers, with 25 percent of suicides in adolescents being related to alcohol abuse.<ref name="understanding_suicidal_behaviour_a02">{{Cite book| last1 = O'Connor | first1 = Rory | last2 = Sheehy | first2 = Noel | title = Understanding suicidal behaviour | url = {{google books |plainurl=y |id=79hEYGdDA3oC}} | date = 29 January 2000 | publisher = BPS Books | location = Leicester | isbn = 978-1-85433-290-5 | pages = 33–37 }}</ref> Among those with [[alcohol dependence]] after one year, some met the criteria for low-risk drinking, even though only 25.5 percent of the group received any treatment, with the breakdown as follows: 25 percent were found to be still dependent, 27.3 percent were in partial remission (some symptoms persist), 11.8 percent asymptomatic drinkers (consumption increases chances of relapse) and 35.9 percent were fully recovered&nbsp;– made up of 17.7 percent low-risk drinkers plus 18.2 percent abstainers.<ref name="NIAAA2002">{{Cite web|url=http://www.nih.gov/news/pr/jan2005/niaaa-18.htm |title=2001–2002 Survey Finds That Many Recover From Alcoholism |last1=The National Institute on Alcohol Abuse and Alcoholism |last2=U.S. Department of Health and Human Services, NIH News |date=18 January 2005 |publisher=National Institutes of Health |url-status=dead |archiveurl=https://web.archive.org/web/20060818230335/http://www.nih.gov/news/pr/jan2005/niaaa-18.htm |archivedate=18 August 2006 }}</ref> In contrast, however, the results of a long-term (60-year) follow-up of two groups of alcoholic men indicated that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence."<ref>{{cite journal | last= Vaillant |first=GE |s2cid=12835128 | title = A 60-year follow-up of alcoholic men | journal = Addiction | volume = 98 | issue = 8 | pages = 1043–51 | date = August 2003 | pmid = 12873238 | doi = 10.1046/j.1360-0443.2003.00422.x | issn = 0965-2140 }}</ref> There was also "return-to-controlled drinking, as reported in short-term studies, is often a mirage."
 
==History==
[[File:Adriaen Brouwer - Inn with drunken peasants.jpg|thumb|[[Adriaen Brouwer]], ''Inn with Drunken Peasants'', 1620s]]
[[File:1904 Claim of Alcoholism Being Disease4.jpg|thumb|upright=0.7|right|1904 advertisement describing alcoholism as a disease.]]
Historically the name "[[dipsomania]]" was coined by German physician [[C.W. Hufeland]] in 1819 before it was superseded by "alcoholism".<ref name="lexikon_psychiatrie_psychotherapie_medizinische_psychologie">{{Cite book| last1 = Peters | first1 = Uwe Henrik | title = Lexikon Psychiatrie, Psychotherapie, Medizinische Psychologie|url={{google books |plainurl=y |id=qY6_DQAAQBAJ}} | year = 2007 | publisher = Urban Fischer bei Elsev | isbn = 978-3-437-15061-6 }}</ref><ref>{{Cite book| last = Valverde | first = Mariana | title = Diseases of the Will |page=48|url={{google books |plainurl=y |id=Kl5ugmvDgH0C|page=4848}} | publisher = Cambridge University Press | location = Cambridge | year = 1998 | isbn = 978-0-521-64469-3 }}</ref> That term now has a more specific meaning.<ref>{{Cite book |last1=Tracy | first1 = Sarah J. | title = Alcoholism in America: from reconstruction to prohibition | url = {{google books |plainurl=y |id=JkYyd4qmme0C|page=31}} | year= 2005 | publisher = Johns Hopkins University Press | location = Baltimore | isbn = 978-0-8018-8119-0 | pages = 31–52 }}</ref> The term "alcoholism" was first used in 1849 by the Swedish physician Magnus Huss to describe the systematic adverse effects of alcohol.<ref>{{Cite book|title=Alcoholismus chronicus, eller Chronisk alkoholssjukdom|url={{google books |plainurl=y |id=wt6r2Zw8sCEC|page=5}}|publisher=Stockholm und Leipzig|accessdate=19 February 2008|year=1852}}</ref>
Alcohol has a long history of use and misuse throughout recorded history. Biblical, Egyptian and Babylonian sources record the history of abuse and dependence on alcohol. In some ancient cultures alcohol was worshiped and in others, its abuse was condemned. Excessive alcohol misuse and drunkenness were recognized as causing social problems even thousands of years ago. However, the defining of habitual drunkenness as it was then known as and its adverse consequences were not well established medically until the 18th century. In 1647 a Greek monk named Agapios was the first to document that chronic alcohol misuse was associated with toxicity to the nervous system and body which resulted in a range of medical disorders such as seizures, paralysis, and internal bleeding. In 1920 the effects of alcohol abuse and chronic drunkenness boosted membership of the [[temperance movement]] and led to the [[Prohibition in the United States|prohibition of alcohol in the United States]], a nationwide constitutional ban on the production, importation, transportation, and sale of alcoholic beverages that remained in place until 1933; this policy resulted in the decline of death rates from cirrhosis and alcoholism.<ref name="Blocker2006">{{cite journal |last1=Blocker |first1=Jack S. |title=Did Prohibition Really Work? Alcohol Prohibition as a Public Health Innovation |journal=American Journal of Public Health |date=February 2006 |volume=96 |issue=2 |pages=233–43 |doi=10.2105/AJPH.2005.065409|pmid=16380559 |pmc=1470475 |quote=Nevertheless, once Prohibition became the law of the land, many citizens decided to obey it. Referendum results in the immediate post-Volstead period showed widespread support, and the Supreme Court quickly fended off challenges to the new law. Death rates from cirrhosis and alcoholism, alcoholic psychosis hospital admissions, and drunkenness arrests all declined steeply during the latter years of the 1910s, when both the cultural and the legal climate were increasingly inhospitable to drink, and in the early years after National Prohibition went into effect.}}</ref> In 2005 alcohol dependence and abuse was estimated to cost the US economy approximately 220&nbsp;billion dollars per year, more than cancer and obesity.<ref name="soa2008">{{Cite book|last1=Potter |first1= James V. |volume=2 |title=Substances of Abuse |url={{google books |plainurl=y |id=WU73eJAIDI4C|page=1}} |year= 2008 |publisher=AFS Publishing Co |isbn=978-1-930327-46-7 |pages=1–13 }}</ref>
 
==Society and culture==
{{see also|List of deaths through alcohol}}
 
The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to society, for example, money due to lost labor-hours, medical costs due to injuries due to drunkenness and organ damage from long-term use, and secondary treatment costs, such as the costs of rehabilitation facilities and detoxification centers. Alcohol use is a major contributing factor for [[head injury|head injuries]], [[motor vehicle injuries]]s (27%), [[interpersonal violence]] (18%), [[suicides]] (18%), and [[epilepsy]] (13%).<ref>{{cite web |title=Alcohol and health |url=https://www.who.int/substance_abuse/infographic_alcohol_2018.pdf?ua=1 |website=WHO |accessdate=3 May 2020}}</ref> Beyond the financial costs that alcohol consumption imposes, there are also significant social costs to both the alcoholic and their family and friends.<ref name="Jessica Kingsley Publishers">{{Cite book |last1=McCully |first1=Chris |title=Goodbye Mr. Wonderful. Alcohol, Addition and Early Recovery |url=http://www.jkp.com/catalogue/book/9781843102656/contents |year=2004 |publisher=Jessica Kingsley Publishers |location=London |isbn=978-1-84310-265-6 |url-status=live |archiveurl=https://web.archive.org/web/20091121091734/http://www.jkp.com/catalogue/book/9781843102656/contents |archivedate=21 November 2009 }}</ref> For instance, alcohol consumption by a pregnant woman can lead to an incurable and damaging condition known as [[fetal alcohol syndrome]], which often results in [[cognitive deficit]]s, mental health problems, an inability to live independently and an increased risk of criminal behaviour, all of which can cause emotional stress for parents and caregivers.<ref>{{Cite book| last1 = Streissguth | first1 = Ann Pytkowicz | title = Fetal alcohol syndrome: a guide for families and communities |year=2018| publisher = Paul H Brookes Pub. |url={{google books |plainurl=y |id=kptHAAAAMAAJ}} | location = Baltimore| isbn = 978-1-55766-283-5 }}</ref><ref>{{Cite web |url=https://www.cdc.gov/ncbddd/fasd/documents/FAS_guidelines_accessible.pdf |title=Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis |first1=Julie Louise |last1=Gerberding |first2=José |last2=Cordero |first3=R. Louise |last3=Floyd |date=May 2005 |publisher=US Centers for Disease Control and Prevention |url-status=live |archiveurl=https://web.archive.org/web/20140611110732/http://www.cdc.gov/ncbddd/fasd/documents/FAS_guidelines_accessible.pdf |archivedate=11 June 2014 }}</ref> Estimates of the economic costs of alcohol abuse, collected by the World Health Organization, vary from one to six percent of a country's GDP.<ref>{{Cite web| publisher=World Health Organization | url=http://www.who.int/substance_abuse/publications/global_status_report_2004_overview.pdf | title=Global Status Report on Alcohol 2004 | accessdate=3 January 2007 | archiveurl= https://web.archive.org/web/20061230103251/http://www.who.int/substance_abuse/publications/global_status_report_2004_overview.pdf| archivedate= 30 December 2006 | url-status= live}}</ref> One Australian estimate pegged alcohol's social costs at 24% of all drug abuse costs; a similar Canadian study concluded alcohol's share was 41%.<ref>{{Cite web|publisher=World Health Organization Global Alcohol Database |url=http://www.who.int/globalatlas/dataQuery/objectInterface.asp?objID=359&boCat=&p=null&lvl=0&catID=520700000000&level=2 |accessdate=3 January 2007 |title=Economic cost of alcohol consumption |url-status=dead |archiveurl=https://web.archive.org/web/20080118052306/http://www.who.int/globalatlas/dataQuery/objectInterface.asp?objID=359&boCat=&p=null&lvl=0&catID=520700000000&level=2 |archivedate=18 January 2008 }}</ref> One study quantified the cost to the UK of ''all'' forms of alcohol misuse in 2001 as £18.5–20&nbsp;billion.<ref name="cosu"/><ref>{{Cite news | publisher=BBC | url=http://news.bbc.co.uk/1/hi/health/3122244.stm | title=Q&A: The costs of alcohol | date=19 September 2003 | url-status=live | archiveurl=https://web.archive.org/web/20061019030402/http://news.bbc.co.uk/1/hi/health/3122244.stm | archivedate=19 October 2006 | df=dmy-all }}</ref> All economic costs in the United States in 2006 have been estimated at $223.5&nbsp;billion.<ref>{{cite journal |last1=Bouchery |first1=EE |last2=Harwood |first2=HJ |last3=Sacks |first3=JJ |last4=Simon |first4=CJ |last5=Brewer |first5=RD |title=Economic Costs of Excessive Alcohol Consumption in the U.S., 2006 |journal=American Journal of Preventive Medicine |volume=41 |issue=5 |pages=516–24 |year=2011 |pmid=22011424 |doi=10.1016/j.amepre.2011.06.045 |url=http://www.sertox.com.ar/img/item_full/Bouchery_2011.pdf |citeseerx=10.1.1.460.5582 |access-date=12 December 2017 |archive-url=https://web.archive.org/web/20180721201648/https://www.sertox.com.ar/img/item_full/Bouchery_2011.pdf |archive-date=21 July 2018 |url-status=dead }}</ref>
 
{{anchor|Hitting rock bottom}}The idea of '''hitting rock bottom''' refers to an experience of [[Psychological stress|stress]] that is blamed on alcohol misuse. &nbsp;There is no single definition for this idea, and people may identify their own lowest points in terms of lost jobs, lost relationships, health problems, legal problems, or other consequences of alcohol misuse.<ref name=":0">{{Cite journal|last1=Kirouac|first1=Megan|last2=Witkiewitz|first2=Katie|date=15 October 2017|title=Identifying "Hitting Bottom" among Individuals with Alcohol Problems: Development and Evaluation of the Noteworthy Aspects of Drinking Important to Recovery (NADIR)|journal=Substance Use & Misuse|volume=52|issue=12|pages=1602–1615|doi=10.1080/10826084.2017.1293104|issn=1082-6084|pmc=6107067|pmid=28557550}}</ref> &nbsp;The concept is promoted by 12-step recovery groups and researchers using the [[transtheoretical model]] of motivation for behavior change.<ref name=":0" /> &nbsp;The first use of this slang phrase in the formal [[medical literature]] appeared in a 1965 [[Literature review|review]] in the ''British Medical Journal'',<ref name=":0" /> which said that some men refused treatment until they "hit rock bottom", but that treatment was generally more successful for "the alcohol addict who has friends and family to support him" than for impoverished and homeless addicts.<ref>{{Cite journal|date=24 July 1965|title=Treatment of Alcohol Addiction|journal=British Medical Journal|volume=2|issue=5455|pages=184–185|issn=0007-1447|pmc=1846501|pmid=20790596|doi=10.1136/bmj.2.5455.184}}</ref>
 
[[Stereotype]]s of alcoholics are often found in [[fiction]] and [[popular culture]]. The "[[town drunk]]" is a [[stock character]] in Western popular culture. Stereotypes of drunkenness may be based on [[racism]] or [[xenophobia]], as in the fictional depiction of the [[Irish people|Irish]] as heavy drinkers.<ref>{{Cite web | url=http://www.finfacts.ie/Private/bestprice/alcoholdrinkconsumptionpriceseurope.htm | title=World/Global Alcohol/Drink Consumption | year=2009 | publisher=Finfacts Ireland | url-status=live | archiveurl=https://web.archive.org/web/20150512161159/http://www.finfacts.ie/Private/bestprice/alcoholdrinkconsumptionpriceseurope.htm | archivedate=12 May 2015 | df=dmy-all }}</ref> Studies by social psychologists Stivers and Greeley attempt to document the perceived prevalence of high alcohol consumption amongst the Irish in America.<ref>{{Cite book| last1 = Stivers | first1 = Richard | title = Hair of the dog: Irish drinking and its American stereotype |year=2000| publisher = Continuum | location = New York |url={{google books |plainurl=y |id=MH3aAAAAMAAJ}} | isbn = 978-0-8264-1218-8 }}</ref> Alcohol consumption is relatively similar between many European cultures, the United States, and Australia. In Asian countries that have a high gross domestic product, there is heightened drinking compared to other Asian countries, but it is nowhere near as high as it is in other countries like the United States. It is also inversely seen, with countries that have very low gross domestic product showing high alcohol consumption.<ref>{{cite journal |last1=Chen |first1=CC |last2=Yin |first2=SJ | title = Alcohol abuse and related factors in Asia | journal = [[International Review of Psychiatry]] | volume = 20 | issue = 5 | pages = 425–33 | year = 2008 | pmid = 19012127 | doi = 10.1080/09540260802344075 }}</ref> In a study done on Korean immigrants in Canada, they reported alcohol was even an integral part of their meal, and is the only time solo drinking should occur. They also believe alcohol is necessary at any social event as it helps conversations start.<ref>{{cite journal | last= Wooksoo |first=K | year = 2009 | title = Drinking Culture of Elderly Korean Immigrants in Canada: A Focus Group Study | url = | journal = Journal of Cross-Cultural Gerontology | volume = 24 | issue = 4| pages = 339–53 |doi=10.1007/s10823-009-9104-z |pmid=19823926 }}</ref>
 
Caucasians have a much lower abstinence rate (11.8%) and much higher tolerance to symptoms (3.4±2.45 drinks) of alcohol than Chinese (33.4% and 2.2±1.78 drinks respectively). Also, the more acculturation there is between cultures, the more influenced the culture is to adopt Caucasians drinking practices.<ref>{{cite journal | last1= Li |first1=H Z |last2=Rosenblood |first2=L | year = 1994 | title = Exploring factors influencing alcohol consumption patterns among Chinese and Caucasians | url = | journal = Journal of Studies on Alcohol | volume = 55 | issue = 4|pages=427–33 | doi=10.15288/jsa.1994.55.427|pmid=7934050 }}</ref> [[Peyote]], a psychoactive agent, has even shown promise in treating alcoholism. Alcohol had actually replaced peyote as [[Indigenous peoples of the Americas|Native Americans]]’ psychoactive agent of choice in rituals when peyote was outlawed.<ref>{{cite journal | last= French |first=L | year = 2008 | title = Psychoactive agents and Native American spirituality: Past and present | url = | journal = Contemporary Justice Review | volume = 11 | issue = 2| pages = 155–63 | doi=10.1080/10282580802058270}}</ref>
 
==Research==
===Topiramate===
[[Topiramate]], a derivative of the naturally occurring sugar monosaccharide D-fructose, has been found effective in helping alcoholics quit or cut back on the amount they drink. Evidence suggests that topiramate antagonizes excitatory glutamate receptors, inhibits dopamine release, and enhances inhibitory gamma-aminobutyric acid function. A 2008 review of the effectiveness of topiramate concluded that the results of published trials are promising, however, as of 2008, data was insufficient to support using topiramate in conjunction with brief weekly compliance counseling as a first-line agent for alcohol dependence.<ref>{{cite journal |last1=Olmsted |first1=CL |last2=Kockler |first2=DR |s2cid=27071889 | title = Topiramate for alcohol dependence | journal = Ann Pharmacother | volume = 42 | issue = 10 | pages = 1475–80 | date = October 2008 | pmid = 18698008 | doi = 10.1345/aph.1L157 | issn = 1060-0280 }}</ref> A 2010 review found that topiramate may be superior to existing alcohol pharmacotherapeutic options. Topiramate effectively reduces craving and alcohol withdrawal severity as well as improving quality-of-life-ratings.<ref>{{cite journal |last1=Kenna |first1=GA |last2=Lomastro |first2=TL |last3=Schiesl |first3=A |last4=Leggio |first4=L |last5=Swift |first5=RM | title = Review of topiramate: an antiepileptic for the treatment of alcohol dependence | journal = Curr Drug Abuse Rev | volume = 2 | issue = 2 | pages = 135–42 | date = May 2009 | pmid = 19630744 | doi = 10.2174/1874473710902020135 }}</ref>
 
===Baclofen===
[[Baclofen]], a [[GABAB receptor]] agonist, is under study for the treatment of alcoholism.<ref>{{cite journal |last1=Leggio |first1=L |last2=Garbutt |first2=JC |last3=Addolorato |first3=G | title = Effectiveness and safety of baclofen in the treatment of alcohol dependent patients | journal = CNS & Neurological Disorders Drug Targets | volume = 9 | issue = 1 | pages = 33–44 | date = March 2010 | pmid = 20201813 | doi = 10.2174/187152710790966614 }}</ref> A 2019 systematic review concluded that there is insufficient evidence to draw any conclusions about the safety and efficacy because the evidence is of low quality and insufficient.<ref>{{Cite journal|last1=Liu|first1=Jia|last2=Wang|first2=Lu-Ning|date=6 November 2019|title=Baclofen for alcohol withdrawal|journal=The Cochrane Database of Systematic Reviews|volume=2019|issue=11|pages=|doi=10.1002/14651858.CD008502.pub6|issn=1469-493X|pmc=6831488|pmid=31689723}}</ref> In 2018 baclofen received a Marketing Authorization for use in alcoholism treatment from the French drug agency ANSM if all other treatments are not effective.<ref>{{cite web |title=Autorisation du baclofène : des conditions d'utilisation trop restrictives ? - A la une |url=https://destinationsante.com/autorisation-du-baclofene-des-conditions-dutilisation-trop-restrictives.html |website=Destination Santé |language=fr-FR |date=25 October 2018}}</ref>
 
===Ondansetron===
[[Ondansetron]], a 5HT3 antagonist, appears to have promise as a treatment.<ref>{{cite journal | last1= Kenna |first1=GA | title = Medications acting on the serotonergic system for the treatment of alcohol dependent patients | journal = Current Pharmaceutical Design | volume = 16 | issue = 19 | pages = 2126–35 | year = 2010 | pmid = 20482508 | doi = 10.2174/138161210791516396 }}</ref>
 
===LSD===
According to a retrospective analysis of six studies from the 1960s and 1970s [[Psychedelic therapy|LSD-assisted psychotherapy]] has potential as a treatment for alcoholism.<ref>{{Cite journal|last=Frood|first=Arran|date=9 March 2012|title=LSD helps to treat alcoholism|url=https://www.nature.com/news/lsd-helps-to-treat-alcoholism-1.10200|journal=Nature|doi=10.1038/nature.2012.10200|issn=1744-7933}}</ref><ref>{{Cite journal|last1=Garcia-Romeu|first1=Albert|last2=Davis|first2=Alan K|last3=Erowid|first3=Fire|last4=Erowid|first4=Earth|last5=Griffiths|first5=Roland R|last6=Johnson|first6=Matthew W|date=14 May 2019|title=Cessation and reduction in alcohol consumption and misuse after psychedelic use|journal=Journal of Psychopharmacology|volume=33|issue=9|language=en|pages=1088–1101|doi=10.1177/0269881119845793|pmid=31084460|issn=0269-8811}}</ref> [[Bill W.|Bill Wilson]], the founder of [[Alcoholics Anonymous]], believed LSD might help alcoholics achieve sobriety.<ref>{{Cite news|url=https://www.theguardian.com/science/2012/aug/23/lsd-help-alcoholics-theory|title=LSD could help alcoholics stop drinking, AA founder believed|newspaper=[[The Guardian]]|date=23 August 2012|last1=Hill|first1=Amelia}}</ref>
 
==Henvisninger==
{{Reflist}}
 
==Eksterne henvisninger==
{{Medical condition classification and resources
| DiseasesDB =
| ICD10 = {{ICD10|F|10||f|10}}.2
| ICD9 = {{ICD9|303}}
| ICDO =
| OMIM = 103780
| MedlinePlus = 000944
| eMedicineSubj = article
| eMedicineTopic = 285913
| MeshID = D000437
}}
 
{{Sister project links|wikt=alcoholism|b=no|q=Alcoholism|s=no|commons=Category:Alcoholism|n=no|v=no|species=no|position=left}}
* {{Curlie|Health/Addictions/Substance_Abuse/Alcohol/|Alcohol}}
Hentet fra "https://da.wikipedia.org/wiki/Bruger:Metalindustrien/Kasse6"