The simple fact is that every alcoholic starts as a moderate consumer of alcohol. He or she may or may not have a genetic predisposition, but, the reality is that if he or she had never tasted alcohol his or her vulnerability would not have been exposed.
There are at least 75 verses in the Bible against wine or drunkenness. However, unfortunately, Christianity’s message on the issue becomes ambiguous as wine is a part of its sacraments also. In the majority of Western Christianity, the generally accepted definition of a sacrament is that it is an outward sign that conveys spiritual grace through Christ. Christian churches, denominations, and sects are divided regarding the number and operation of the sacraments. The outward component of sacraments entails the use of such things as water, oil, bread and wine.
Unlike the Bible, the Holy Quran has a very precise and unambiguous message about alcohol:
“They ask thee (Muhammad) concerning wine and the game of hazard. Say: ‘In both there is great sin and also some advantages for men; but their sin is greater than their advantage.’ And they ask thee what they should spend. Say: ‘What you can spare.’ Thus does Allah make His commandments clear to you that you may reflect.” (Al Quran 2:220)
“O ye who believe! wine and the game of hazard and idols and divining arrows are only an abomination of Satan’s handiwork. So shun each one of them that you may prosper. Satan desires only to create enmity and hatred among you by means of wine and the game of hazard, and to keep you back from the remembrance of Allah and from Prayer. But will you keep back?”
(Al Quran 5:91-92)
In these verses the Quran not only prohibits alcohol but also gives reasons behind the prohibition and enlightens us with criteria to judge useful from harmful!
Alcoholism has multiple and conflicting definitions. In common and historic usage, alcoholism is any condition that results in the continued consumption of alcoholic beverages, despite health problems and negative social consequences. Modern medical definitions describe alcoholism as a disease and addiction which results in a persistent use of alcohol despite negative consequences. In the 19th and early 20th centuries, alcoholism, also referred to as dipsomania described a preoccupation with, or compulsion toward the consumption of, alcohol and/or an impaired ability to recognize the negative effects of excessive alcohol consumption.
Although not all of these definitions specify current and on-going use of alcohol as a qualifier for alcoholism, some do, as well as remarking on the long-term effects of consistent, heavy alcohol use, including dependence and symptoms of withdrawal.
While the ingestion of alcohol is, by definition, necessary to develop alcoholism, the use of alcohol does not predict the development of alcoholism. The quantity, frequency and regularity of alcohol consumption required to develop alcoholism varies greatly from person to person. In addition, although the biological mechanisms underpinning alcoholism are uncertain, some risk factors, including social environment, stress, mental health, genetic predisposition, age, ethnicity and gender have been identified. Also, studies indicate that the proportion of men with alcohol dependence is higher than the proportion of women, 7% and 2.5% respectively, although women are more vulnerable to long-term consequences of alcoholism. Around 90% of adults in United States consume alcohol, and more than 700,000 of them are treated daily for alcoholism. Professor David Zaridze, who led the international research team, calculated that alcohol had killed three million Russians since 1987.
The definitions of alcoholism and related terminology vary significantly between the medical community, treatment programs, and the general public.
The National Council on Alcoholism and Drug Dependence and The American Society of Addiction Medicine define alcoholism 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.” The DSM-IV (the dominant diagnostic manual in psychiatry and psychology) defines alcohol abuse as repeated use despite recurrent adverse consequences. It further defines alcohol dependence as alcohol abuse combined with tolerance, withdrawal, and an uncontrollable drive to drink. (See DSM diagnosis below.) Within psychology and psychiatry, alcoholism is the popular term for alcohol dependence. Note that there is debate whether dependence in this use is physical (characterised by withdrawal), psychological (based on reinforcement), or both.Terminology
Many terms are applied to a drinker’s relationship with alcohol. Use, misuse, heavy use, abuse, addiction, and dependence are all common labels used to describe drinking habits, but the actual meaning of these words can vary greatly depending upon the context in which they are used. Even within the medical field, the definition can vary between areas of specialization. Because alcoholism is often used in a derogatory sense in politics and religion, the meanings of the words surrounding it are often used imprecisely.
Use refers to simple use of a substance. An individual who drinks any alcoholic beverage is using alcohol. Misuse, problem use, abuse, and heavy use do not have standard definitions, but suggest consumption of alcohol to the point where it causes physical, social, or moral harm to the drinker. The definitions of social and moral harm are highly subjective and therefore differ from individual to individual.
Moderate Use is defined by The Dietary Guidelines for Americans as no more than two alcoholic beverages per day for men and no more than one alcoholic beverage per day for women.
Within politics, abuse is often used to refer to the illegal use of any substance. Within the broad field of medicine, abuse sometimes refers to use of prescription medications in excess of the prescribed dosage, sometimes refers to use of a prescription drug without a prescription, and sometimes refers to use that results in long-term health problems. Within religion, abuse can refer to any use of a poorly regarded substance. The term is often avoided because it can cause confusion with audiences that do not necessarily share a single definition.
Remission is often used to refer to a state where an alcoholic is no longer showing symptoms of alcoholism. The American Psychiatric Association considers remission to be a condition where the physical and mental symptoms of alcoholism are no longer evident, regardless of whether or not the person is still drinking. They further subdivide those in remission into early or sustained, and partial or full.
The term dipsomania is used in medical and psychiatric circles to identify a condition which is characterized by the uncontrollable craving for alcohol or other intoxicants, which manifests for unknown reasons, and can be confused with alcoholism.
About 40 percent of those who begin drinking alcohol before age 14 develop alcohol dependence, whereas only 10 percent of those who did not begin drinking until 20 years or older developed an alcohol problem in later life. Alcohol abuse during adolescence may lead to long-term changes in the brain which leaves them at increased risk of alcoholism in later years; genetic factors also influence age of onset of alcohol abuse and risk of alcoholism.
The age of onset of drinking as well as genetic factors are associated with an increased risk of the development of alcoholism. Age and genetic factors influence the risk of developing alcohol related neurotoxicity. Recent research has found that alcohol use at an early age may itself directly influence the risk of developing alcoholism via influencing the expression of genes which increase the risk of alcohol dependence. This increased risk may be due to the highly sensitive developing adolescent brain which leads to modulating of the genetic state of the brain which in turn primes the adolescent for increased risk of alcohol dependence. Individuals who have a pre-existing vulnerability to alcoholism are also more likely to begin drinking earlier than average. Genetic traits which influence the risk of the development of alcoholism are associated with a family history of alcoholism. The risk taking behavior associated with adolescence promotes binge drinking. About 40 percent of alcoholics were drinking excessively by late adolescence. Most alcoholics develop alcoholism during adolescence or young adulthood. Severe childhood trauma is also associated with an increased risk of alcohol or other drug problems. There is evidence that a complex mixture of genetic factors as well as environmental factors, e.g. stressful childhood events, influence the risk of the development of alcoholism. Genes which influence the metabolism of alcohol also influence the risk of alcoholism. Good peer and family support reduce the risk of alcoholism developing.
Signs and symptoms
Effects of long term alcohol misuse
The primary effect of alcoholism is to encourage the sufferer to drink at times and in amounts that are damaging to physical health. The secondary damage caused by an inability to control one’s drinking manifests in many ways. Alcoholism also has significant social costs to both the alcoholic and their family and friends. Alcoholism can have adverse effects on mental health causing psychiatric disorders to develop. Approximately 18 percent of alcoholics commit suicide. Research has found that over fifty percent of all suicides are associated with alcohol or drug dependence. When we examine suicide statistics, one is amazed to find that in 2006 more than 33,000 suicides occurred in the U.S. Among young adults ages 15 to 24 years old, there are approximately 100-200 attempts for every completed suicide. In 2007, 14.5% of U.S. high school students reported that they had seriously considered attempting suicide during the 12 months preceding the survey; 6.9% of students reported that they had actually attempted suicide one or more times during the same period.
In adolescents the figure is higher with alcohol or drug misuse playing a role in up to 70 percent of suicides. Alcoholism also has a significant adverse impact on mental health. The risk of suicide among alcoholics has been determined to be 5,080 times that of the general public.
- Physical health effects
It is common for a person suffering from alcoholism to drink well after physical health effects start to manifest. The physical health effects associated with alcohol consumption may include cirrhosis of the liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, increased chance of cancer, nutritional deficiencies, sexual dysfunction, and death from many sources. Severe cognitive problems are not uncommon in alcoholics. Approximately 10% of all dementia cases are alcohol related making alcohol the 2nd leading cause of dementia.
- Mental health effects
Long term misuse of alcohol can cause a wide range of mental health effects. Alcohol misuse is not only toxic to the body but also to brain function and thus psychological well being can be adversely affected by the long-term effects of misuse. Psychiatric disorders are common in alcoholics, especially anxiety and depression disorders, with as many as 25% of alcoholics presenting with severe psychiatric disturbances. Typically these psychiatric symptoms caused by alcohol misuse initially worsen during alcohol withdrawal but with abstinence these psychiatric symptoms typically gradually improve or disappear altogether. Psychosis, confusion and organic brain syndrome may be induced by chronic alcohol abuse which can lead to a misdiagnosis of major mental health disorders such as schizophrenia. Panic disorder can develop as a direct result of long term alcohol misuse. Panic disorder can also worsen or occur as part of the alcohol withdrawal syndrome. Chronic alcohol misuse can cause panic disorder to develop or worsen an underlying panic disorder via distortion of the neurochemical system in the brain.
The co-occurrence of major depressive disorder and alcoholism is well documented. Among those with comorbid occurrences, a distinction is commonly made between depressive episodes that are secondary to the pharmacological or toxic effects of heavy alcohol use and remit with abstinence, and depressive episodes that are primary and do not remit with abstinence. Additional use of other drugs may increase the risk of depression in alcoholics. Depressive episodes with an onset prior to heavy drinking or those that continue in the absence of heavy drinking are typically referred to as “independent” episodes, whereas those that appear to be etiologically related to heavy drinking are termed “substance-induced”. There is a high rate of suicide in chronic alcoholics with the risk of suicide increasing the longer a person drinks. The reasons believed to cause the increased risk of suicide in alcoholics include the long-term abuse of alcohol causing physiological distortion of brain chemistry as well as the social isolation which is common in alcoholics. Suicide is also very common in adolescent alcohol abusers, with 1 in 4 suicides in adolescents being related to alcohol abuse.
The social problems arising from alcoholism can be massive and are caused in part due to the serious pathological changes induced in the brain from prolonged alcohol misuse and partly because of the intoxicating effects of alcohol. Alcohol abuse is also associated with increased risks of committing criminal offences including child abuse, domestic violence, rapes, burglaries and assaults. Being drunk or hung over during work hours can result in loss of employment, which can lead to financial problems including the loss of living quarters. Drinking at inappropriate times, and behavior caused by reduced judgment, can lead to legal consequences, such as criminal charges for drunk driving or public disorder, or civil penalties for tortious behavior. An alcoholic’s behavior and mental impairment while drunk can profoundly impact surrounding family and friends, possibly leading to marital conflict and divorce, or contributing to domestic violence. This can contribute to lasting damage to the emotional development of the alcoholic’s children, even after they reach adulthood. The alcoholic could suffer from loss of respect from others who may see the problem as self-inflicted and easily avoided.
Disability-adjusted life yearfor alcohol use disorders per 100,000 inhabitants in 2002.
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.” In the United Kingdom, the number of ‘dependent drinkers’ was calculated as over 2.8 million in 2001. The World Health Organization estimates that about 140 million people throughout the world suffer from alcohol dependence. In the United States and western Europe 10 to 20% of men and 5 to 10% of women at some point in their lives will meet criteria for alcoholism.
Within the medical and scientific communities, there is 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).”
Current evidence indicates that in both men and women, alcoholism is 50-60% genetically determined, leaving 40-50% for environmental influences.
A 2002 study by the National Institute on Alcohol Abuse and Alcoholism surveyed a group of 4,422 adults meeting the criteria for alcohol dependence and found that after one year, some met the authors’ criteria for low-risk drinking, even though only 25.5% of the group received any treatment, with the breakdown as follows:
- 25% still dependent
- 27.3% in partial remission (some symptoms persist)
- 11.8% asymptomatic drinkers (consumption increases chances of relapse)
- 35.9% fully recovered — made up of 17.7% low-risk drinkers plus 18.2% abstainers.
In contrast, however, the results of a long term (60 year) follow-up of two groups of alcoholic men by George Vaillant at Harvard Medical School indicated that “return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence.” Vaillant also noted that “return-to-controlled drinking, as reported in short-term studies, is often a mirage.”
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