Alcohol dependence

AUDIT has replaced older screening tools such as CAGE but there are many shorter alcohol screening tools,[7] mostly derived from the AUDIT. The Severity of Alcohol Dependence Questionnaire (SAD-Q) is a more specific twenty-item inventory for assessing the presence and severity of alcohol dependence. Other common substances that cause dependence are nicotine and pain relievers, particularly narcotics.

Drugs & Supplements

Also, as noted earlier, alcohol-related admissions to hospital increase steeply with age although the prevalence of heavy drinking is lower in this group. This may partly reflect the cumulative effects of lifetime alcohol consumption as well as the general increasing risk of hospital admission with advancing age. As has been noted previously, relationships with parents, carers and the children in their care are often damaged by alcohol misuse (Copello et al., 2005).

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Additional evidence indicates that behavioral measures indicating a reduced sensitivity to rewarding stimuli (i.e., anhedonia) are exaggerated in rats that experience withdrawal from repeated alcohol injections compared with rats tested during withdrawal from a single alcohol injection (Schulteis and Liu 2006). Finally, a history of multiple withdrawal experiences can exacerbate cognitive deficits and disruption of sleep during withdrawal (Borlikova et al. 2006; Stephens et al. 2005; Veatch 2006). Taken together, these results indicate that chronic alcohol exposure involving repeated withdrawal experiences exacerbates withdrawal symptoms that significantly contribute to a negative emotional state, which consequently renders dependent subjects more vulnerable to relapse. Another molecule involved in regulating the body’s stress response is called neuropeptide-Y (NPY).

Early Exposure as a Predictor of Later Alcohol Abuse

Specific social problems such as homelessness, isolation, marital breakdown, child care issues including parenting problems, child abuse and neglect will require referral to, and liaison with, appropriate social care services (National Treatment Agency for Substance Misuse, 2006). A proportion of service users entering specialist treatment are involved with the criminal justice system and some may be entering treatment as a condition of a court order. Therefore, appropriate liaison with criminal justice services is essential for ecstasy detox symptoms timeline medications and treatment this group. Meanwhile, the chances of developing many chronic diseases increase as people get older, and alcohol consumption can amplify some of these risks. Regular alcohol consumption is a major risk factor for liver disease and head and neck cancer, and chronic alcohol use has been linked with an acceleration of age-related cognitive decline and brain atrophy. Research has found that having as little as one alcoholic beverage per day increases a woman’s risk of breast cancer, especially for estrogen-receptor positive tumors.

Studying Alcohol Relapse Behavior

Evidence from genetic studies, particularly those in twins, has clearly demonstrated a genetic component to the risk of alcohol dependence. A meta-analysis of 9,897 twin pairs from Australian and US studies found the heritability of alcohol dependence to be in excess of 50% (Goldman et al., 2005). However, a meta-analysis of 50 family, twin and adoption studies showed the heritability of alcohol misuse to be at most 30 to 36% (Walters, 2002).

During this initial stage of addiction, opponent processes are also triggered, and these result in a decrease in reward function accompanied by increased brain stress. These processes appear to involve multiple neurotransmitter systems and their modulators, including serotonin (5-HT) [43], understanding alcohol and anger’s connection DA [44], various opioid peptides [33], acetylcholine (ACh) [45], gamma-aminobutyric acid (GABA) [46], and glutamate (Glu) [24,41]. Activation of the HPA axis and CRF-related brain stress circuitry resulting from alcohol dependence likely contributes to amplified motivation to drink.

The anatomical distributions of CRF and NPY are highly overlapping, suggesting that one might serve as a “buffer” for the effects of the other. Although psychiatric comorbidity is common in people seeking help for alcohol-use disorders, this will usually resolve within a few weeks of abstinence from alcohol without formal psychiatric intervention (Petrakis et al., 2002). However, a proportion of people with psychiatric comorbidity, usually those in whom the mental disorder preceded alcohol dependence, will require psychosocial or pharmacological interventions specifically for the comorbidity following assisted withdrawal.

Some studies using animal models involving repeated withdrawals have demonstrated altered sensitivity to treatment with medications designed to quell sensitized withdrawal symptoms (Becker and Veatch 2002; Knapp et al. 2007; Overstreet et al. 2007; Sommer et al. 2008; Veatch and Becker 2005). Moreover, after receiving some of these medications, animals exhibited lower relapse vulnerability and/or a reduced amount consumed once drinking was (re)-initiated (Ciccocioppo et al. 2003; Finn et al. 2007; Funk et al. 2007; Walker and Koob 2008). Indeed, clinical investigations similarly have reported that a history of multiple detoxifications can impact responsiveness to and efficacy of various pharmacotherapeutics used to manage alcohol dependence (Malcolm et al. 2000, 2002, 2007). Future studies should focus on elucidating neural mechanisms underlying sensitization of symptoms that contribute to a negative emotional state resulting from repeated withdrawal experience. Such studies will undoubtedly reveal important insights that spark development of new and more effective treatment strategies for relapse prevention as well as aid people in controlling alcohol consumption that too often spirals out of control to excessive levels.

5The median raphe nucleus is an area in the brain stem that contains a large proportion of the brain’s serotonin neurons and therefore significantly supplies the brain with this important neurotransmitter. As Annie Grace, the author of This Naked Mind, brilliantly puts it, “When there is no perceived benefit, there is no desire.” By reshaping our beliefs about alcohol, we have the power to weaken our cravings. It’s the perfect starting point to help you uncover your hidden beliefs about alcohol and take the first step to weakening your craving. In this story, each blind man touches a different part of the elephant and draws his conclusion about what the elephant is like. One thinks it’s like a wall, another like a snake, and another like a tree trunk, based on the part they touched.

There are relatively few specific specialist alcohol services for people from ethnic minority groups, although some examples of good practice exist (Harrison & Luck, 1997). The dependence-producing properties of alcohol have been studied extensively in the last 20 years. Alcohol affects a wide range of neurotransmitter systems in the brain, leading to the features of alcohol dependence. The main neurotransmitter systems affected by alcohol are gamma-aminobutyric acid (GABA), glutamate, dopamine ketamine addiction: definition symptoms effects and treatment and opioid (Nutt, 1999). The action of alcohol on GABA is similar to the effects of other sedatives such as benzodiazepines and is responsible for alcohol’s sedating and anxiolytic properties (Krystal et al., 2006). Glutamate is a major neurotransmitter responsible for brain stimulation, and alcohol affects glutamate through its inhibitory action on N-methyl D-aspartate (NMDA)-type glutamate receptors, producing amnesia (for example, blackouts) and sedation (Krystal et al., 1999).

1. Instead, clinicians may be obligated to match medication strategies to individuals or AUD subtypes, and this approach demands stronger evidence of treatment efficacy in particular patient groups.
2. Liaison with criminal justice services is necessary to ensure that appropriate co-ordination of care and effective communication and information-sharing protocols are in place.
3. Like the blind men and the elephant, we only get a piece of reality that is just a perception.
4. Alcohol, by promoting γ-aminobutyric acid (GABA) subtype GABAA receptor function, may inhibit GABAergic transmission in the ventral tegmental area (VTA), thereby disinhibiting (i.e., activating) VTA dopamine.
5. Addictions are more likely to result in serious harm, including suicide, unlike tolerance and physical dependence.

Screening and brief intervention delivered by a non-specialist practitioner is a cost-effective approach for hazardous and harmful drinkers (NICE, 2010a). However, for people who are alcohol dependent, brief interventions are less effective and referral to a specialist service is likely to be necessary (Moyer et al., 2002). It is important, therefore, that health and social care professionals are able to identify and appropriately refer harmful drinkers who do not respond to brief interventions, and those who are alcohol dependent, to appropriate specialist services. Addiction psychiatrists also have an important role in liaison with general psychiatrists in the optimal management of people with alcohol and mental health comorbidity (Boland et al., 2008). Significant advancements have been made in understanding the neurobiological underpinnings and environmental factors that influence motivation to drink as well as the consequences of excessive alcohol use. Given the diverse and widespread neuroadaptive changes that are set in motion as a consequence of chronic alcohol exposure and withdrawal, it perhaps is not surprising that no single pharmacological agent has proven to be fully successful in the treatment of alcoholism.

They have a variety of mechanisms, including blockage of sodium channels, enhancing GABA, antagonizing glutamate receptors, and blocking calcium channels. When you first start drinking alcohol, it may have taken only a few drinks for you to feel drunk. The National Center for Drug Abuse Statistics says more than 20 million people over the age of 12 in the United States have substance use disorder.

Substance dependence on alcohol, or alcoholism, is defined by neuroplasticity that is responsible for phenomena such as sensitization, tolerance, and withdrawal as well as for neuron survival, all of which contribute to the development and maintenance of the disorder. In addition to the extant literature on the importance of brain reward circuits in the development of alcohol dependence, recent research has focused on a new contingent of neural systems that play central roles in the regulation of stress and anxiety as well as mediate executive functions. This joint focus on brain arousal, reward, and stress systems, along with the integration of new technologies in the field, is accelerating our understanding of the components of alcohol dependence and contributing to the development of new treatment strategies. Changes in the activity of the reward circuit mediating the acute positive reinforcing effects of alcohol and the stress circuit mediating negative reinforcement of dependence during the transition from nondependent alcohol drinking to dependent drinking. Key elements of the reward circuit are dopamine (DA) and opioid peptide neurons that act at both the ventral tegmental area (VTA) and the nucleus accumbens and which are activated during initial alcohol use and early stages of the progression to dependence (i.e., the binge/intoxication stage).

For the European Union, the US and Canada, social costs of alcohol were estimated to be around €270 billion (2003 prices; Anderson and Baumberg, 2005), US$185 billion (1998 prices; WHO, 2004), and CA$14.6 billion (2002 prices; Rehm et al., 2006), respectively. If you’re simply looking to speak to someone on the phone or chat online for more advice on your own or someone else’s drinking, get in touch with Drinkchat or Drinkline. If you’re worried about your drinking, get in touch with your local GP surgery, who will be able to help. The society that you live in plays an important role in how likely you are to develop problems with alcohol. For example, how easily available alcohol is, how much it costs, and pressure from friends, family or colleagues to drink.

The estimated costs in the workplace amount to some £6.4 billion through lost productivity, absenteeism, alcohol-related sickness and premature deaths (Prime Minister’s Strategy Unit, 2003). Alcohol dependence is also a category of mental disorder in DSM–IV (APA, 1994), although the criteria are slightly different from those used by ICD–10. For example a strong desire or compulsion to use substances is not included in DSM–IV, whereas more criteria relate to harmful consequences of use. It should be noted that DSM is currently under revision, but the final version of DSM–V will not be published until 2013 (APA, 2010).