Alcoholism (redirected from dipsomania)

alcoholism, disease characterized by impaired control over the consumption of alcoholic beverages. Alcoholism is a serious problem worldwide; in the United States the wide availability of alcoholic beverages makes alcohol the most accessible drug, and alcoholism is the most prevalent of the nation's addictions (see drug addiction and drug abuse).

The understanding of alcoholism, and hence its definition, continues to change. Many terms, often with hazy differences in meaning, have been used to describe different stages and manifestations of the disease. In 1992 the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine published a definition reflecting the current understanding of the disease: "Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic." This definition recognizes alcoholism as a disease, i.e., as an involuntary disability. It accepts a genetic vulnerability in some people and identifies the phenomenon of denial as both a psychological defense mechanism and a physiological outcome of alcohol's effect on the memory.

Physical Effects

Intoxication

Although anyone can become intoxicated while drinking, the alcoholic is less likely to recognize the signs and control his or her intake. Intoxication is produced by alcohol as it circulates in the blood and acts to depress the central nervous system (see depressant). Alcohol can pass directly into the bloodstream. The absorption rate depends principally on the concentration of the drug in the stomach and small intestine. This concentration is limited by the presence of alcohol dehydrogenase. Because women normally carry less alcohol dehydrogenase in their intestines, they usually consume less alcohol than men before showing its effects.

Alcohol is not stored in the body or excreted but is metabolized in the liver at a fixed rate of between 0.25 and 0.33 oz (7.1–9.4 grams) per hour, varying with the individual. Thus alcohol is found in the bloodstream and signs of intoxication appear when the rate of alcohol consumption is greater than the rate at which it is metabolized in the liver. At a blood level of about .05%, alcohol impairs concentration, visual function, psychomotor performance, and reaction time. For many years the legal standard for drunkenness in most states was a blood alcohol level of .10%, but in many states it now is .08%. The lethal level, often given as .60%, may be as low as .40% in some people. Blood alcohol concentrations are measured by breath (the Breathalyzer test), blood, or urine tests.

Effects of Chronic Use

Alcohol abuse can result in broad range of medical problems. Alcohol can reduce production of the sex hormone testosterone in males, resulting in impotence and testicular atrophy. Alcohol has a high caloric value but a low nutritional value. Its "empty calories" may allow the alcoholic to feel satisfied while actually progressing toward a state of serious malnutrition. Ailments that can result from alcohol consumption include cirrhosis, a liver ailment; diseases of the digestive system; damage to the heart; lowered resistance to infection; and cancer (larynx, esophagus, liver). Women who consume alcohol during pregnancy are at risk of delivering children with fetal alcohol syndrome, a syndrome of physical, developmental, and psychological problems.

Although the medical effects of alcoholism have long been known, the study of how alcohol acts on the brain to produce intoxication, dependence, and tolerance is still new. Most studies focus on the effect of alcohol on cellular communication. These have found that different regions of the brain differ in their sensitivity to alcohol. In addition, alcohol affects many different kinds of receptors (see nervous system) and neurotransmitters, such as GABA, glutamate, and serotonin, creating different effects in each case. Whatever the exact mechanism, it is accepted that chronic consumption of alcohol results in disconnection of the fibers that connect brain cells, producing memory lapses, impaired learning ability, motor disturbances, and general disorientation. Two organic brain disorders, alcoholic dementia, characterized by general loss of intellectual abilities, and Wernicke-Korsakoff's syndrome, characterized by such symptoms as loss of physical coordination, incoherence, and mental confusion, are frequently seen in alcoholics.

Withdrawal

Alcohol, like all addictive drugs, produces physical dependence in the habitual user. A hangover, a combination of headache, nausea, fatigue, and depression, may be a mild type of withdrawal from alcohol. Sudden abstinence by the chronic alcoholic produces a severe withdrawal syndrome—including tremors, vomiting, and convulsions resembling those of epilepsy—that is more likely to cause death than withdrawal from narcotic drugs. The final and most dangerous phase in this withdrawal pattern is delirium tremens, a toxic psychosis characterized by insomnia, hallucinations, seizures, and maniacal behavior.

Treatment

The treatment of alcoholism depends on how far the disease has progressed. Treatment typically begins with professional advice or self-motivation to abstain, often coupled with medical efforts to achieve sobriety. In the presence of withdrawal symptoms, antianxiety drugs such as benzodiazepines may be prescribed. A next step is often enrollment in a treatment program suitable to the severity of the disease and patient's social stability. Residential programs offer a supportive atmosphere and a structured environment in which the patient can begin to learn how to restructure his or her life and develop new habits. Many programs educate the family as well, alerting them to patterns within the family that may have enabled the patient to keep drinking. Because alcoholism is a chronic recurring and relapsing disease, treatment programs are usually followed by membership in a support group such as Alcoholics Anonymous.

Medical treatment to help ensure continued sobriety includes self-administration of drugs such as Antabuse, which produces severe discomfort if present in the system when alcohol is consumed. Naltrexone, a drug formerly used in heroin abuse, and acamprosate are also now approved for use in the treatment of alcoholism. Naltrexone minimizes both the craving for alcohol and the "high" produced by its consumption. Acamprosate reduces the craving for alcohol in people who have stopped drinking. In addition to these standard treatments, many alcoholics are aided by alternative treatments such as acupuncture and hypnosis.

Costs to Society

Because alcohol can profoundly alter motor control and behavior (by blocking inhibitions, for example, and releasing aggressive behavior), it is one of the most dangerous drugs. A large proportion of arrests in the United States are for driving while under the influence of alcohol, and a high proportion of crimes of violence (e.g., child abuse, homicide, and suicide) are committed by people who have been drinking. In the United States, members of minority groups (with the exception of Asian Americans) are affected disproportionately by alcohol-related problems. At different stages in the course of the disease, the alcoholic may experience problems with family and friends, absenteeism and reduced productivity, accidents, violent behavior, increased tolerance and consumption, or blackouts (periods of alcohol-induced memory loss). As the disease progresses, more and more serious physical and social problems may emerge.

Bibliography

See P. G. Bourne and R. Fox, ed., Alcoholism (1980); E. L. Gomberg et al., ed., Alcohol: Science and Society Revisited (1982); M. Grant and B. Ritson, ed., Alcohol: The Prevention Debate (1983); M. Elkin, Families under the Influence (1984); D. Gallant, Alcoholism: A Guide to Diagnosis, Intervention, and Treatment (1987).

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alcoholism

Excessive habitual consumption of alcoholic beverages despite physical, mental, social, or economic harm (e.g., cirrhosis, drunk driving and accidents, family strife, frequently missing work). Persons who drink large amounts of alcohol over time become tolerant to its effects. Alcoholism is usually considered an addiction and a disease. The causes are unclear, but there may be a genetic predisposition. It is more common in men, but women are more likely to hide it. Treatment may be physiological (with drugs that cause vomiting and a feeling of panic when alcohol is consumed; not an effective long-term treatment), psychological (with therapy and rehabilitation), or social (with group therapies). Group therapies such as Alcoholics Anonymous are the most effective treatments. Suddenly stopping heavy drinking can lead to withdrawal symptoms, including delirium tremens.

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Alcoholism

See also Drunkenness.

Allurement (See TEMPTATION.)

Alcoholics Anonymous (AA)

society of ex-alcoholics who help alcoholics to stop drinking. [Am. Hist.: Flexner, 356]

Bowery, the

area in New York City known for its destitute and drunken population. [Am. Culture: Misc.]

Brick

dipsomaniac; drinks until he feels a “click.” [Am. Lit.: Cat on a Hot Tin Roof]

Emery, Stan

drinking as only means to adjust to world. [Am. Lit.: The Manhattan Transfer]

English, Julian

aristocratic drunkard mistreats his beloved wife, quarrels with everyone, and kills himself after a drunken bout. [Am. Lit.: Appointment in Samarra]

Flyte, Sebastian

drinks to escape from his family, most of whom he detests. [Br. Lit.: Evelyn Waugh Brideshead Revisited in Magill I, 83]

Iceman Cometh, The

portrayal of Harry Hope’s rundown saloon which harbors alcoholics. [Am. Lit.: The Iceman Cometh]

L’Assommoir

study of the demoralizing effects of alcohol. [Fr. Lit.: L’Assommoir]

Lost Weekend, The

study of Don Birnam, an unsuccessful writer who drinks too much. [Am. Lit.: The Lost Weekend, Magill I, 531–532]

Prohibition

resurgence of American puritanism (1920–1933). [Am. Hist.: Allen, 14–15]

skid row

a run-down area frequented by alcoholics. [Am. Culture: Misc.]