Alcohol dependence

An illness characterized by habitual, compulsive, longterm, heavy consumption of alcohol and the development of withdrawal symptoms when drinking is suddenly stopped. Three causative factors interact in the development of the illness: personality, environment, and the addictive nature of alcohol. Inadequate, insecure, or immature personalities are more at risk. Environmental factors are important, especially the ready availability, affordability, and social acceptance of alcohol. Genetic factors may play a part in causing dependence in some cases, but it is now widely believed that anyone, irrespective of personality, environment, or genetic background, can become an alcoholic. Stress is often a major factor in precipitating heavy drinking. Alcohol dependence usually develops in 4 main stages that occur over a number of years. In the 1st phase, tolerance to alcohol develops in the heavy social drinker. In the 2nd phase, the drinker experiences memory lapses relating to events during the drinking episodes. In the 3rd phase, there is loss of control over alcohol consumption. The final phase is characterized by prolonged binges of intoxication and mental or physical complications. Behavioural symptoms are varied and can include furtive, aggressive, or grandiose behaviour; personality changes (such as irritability, jealousy, or uncontrolled anger); neglect of food intake and personal appearance; and lengthy periods of intoxication. Physical symptoms may include nausea, vomiting, or shaking in the morning; abdominal pain; cramps; numbness or tingling; weakness in the legs and hands; irregular pulse; enlarged blood vessels in the face; unsteadiness; confusion; memory lapses; and incontinence. After sudden withdrawal from alcohol, delirium tremens may occur. Alcohol-dependent persons are more susceptible than others to a variety of physical and mental disorders (see alcohol-related disorders). Many alcoholics require detoxification followed by long-term treatment. Different methods of treatment may be combined. Psychological treatments involve psychotherapy and are commonly carried out as group therapy. Social treatments may offer practical help and tend to include family members in the process. Physical treatment generally includes the use of disulfiram, a drug that sensitizes the drinker to alcohol so that he or she experiences unpleasant side effects when drinking. Alcoholics Anonymous and other self-help organizations can provide support and advice.


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