Background

Alcoholism, alcohol use disorder (AUD), or alcohol addiction is a progressive and chronic condition. It creates a strong desire to consume more alcohol instead of it has a negative consequences. It is also considered as a brain disease as it affects the function of brain and have severe complications for a physical and mental health and personal and professional life of a person.  

People who have alcoholism are frequently unable to control their drinking habits and continue to drink it even if it can cause problems in their work, health, and relationships. They may experience the symptoms of withdrawal if they stop the drinking habit and need to consume more alcohol in order to get the same effects. Alcoholism may lead to different physical health problems like heart disease, liver disease, and certain types of cancer. 

Alcoholism can be treated, but the recovery may be a long and very challenging process, and sometimes it also requires professional help. The treatment option is like a combination of medication. Support groups, therapy, and lifestyle changes. People who are having a struggle with alcoholism can get support from friends and family and guidance from healthcare providers.  

Epidemiology

Alcoholism is a severe public health problem that can affect individuals, families, and communities.  

The epidemiological facts of alcoholism are like: 

As per the WHO, alcohol can cause 3 million deaths globally every year. This makes it the third leading cause of avoidable deaths after high blood pressure and tobacco. 

In 2019, around 14.5 million adult people had AUD, which is 5.8 of the population in the American States. Alcoholism is more common in males than females. About 7.9 % of the males and 3.6 % of the females have AUD in the US. 

The rate of alcoholism changes by age. The high rate of AUD is found for those whose age is between 18 to 29 years old (11.7%), whose age is between 30 to 44 years (7.9%), and whose age is between 45 to 64 years (5.6 %) in the US. The low rate is found in those whose age is between 65 years and older (1.7%). 

Certain racial and ethnic groups have a high rate of alcoholism. The high rate of AUD is found in Native Americans (14.9%), compared with whites (6.3%), Hispanics (5.5%), and blacks (4.0%) in the US. 

Alcoholism is linked with different health problems like heart disease, liver disease, specific types of cancer, and mental health problems like anxiety, depression. 

Alcoholism is linked with social problems like unemployment, domestic violence, and poverty. Alcoholism costs the US economy about $249 billion per year in healthcare expenses, lost productivity, and criminal justice costs. 

Anatomy

Pathophysiology

Alcohol affects all the organ systems in the body. Excessive consumption of alcohol can lead to unconsciousness or even fatality. The neurotransmitter systems in the brain which are affected by alcohol include opiates, glutamate, GABA, serotonin, and dopamine. The increased level of opiates can lead to some pleasant sensations induced by alcohol. The GABA can lead to tranquilizing of drug and calming impact.  

Alcohol blocks the glutamate receptor. It can lead to more production of glutamate receptors with a long period of consumption of alcohol. Sudden alcohol withdrawal can lead to more activity in the CNS. Individuals who drink alcohol for prolonged time are more probable to develop alcohol withdrawal syndrome than those individuals who drink for a short period.

Prolonged alcohol use can lead to brain activity, which can lead to cerebellar degeneration, neuronal death, tremors, delirium tremens, Wernicke-Korsakoff syndrome, withdrawal seizures, and alcoholic hallucinosis. Opiate receptors are enlarged in the brains of newly avoiding alcohol-dependent people, and the amount of receptors is linked to drinking more alcohol. 

Etiology

The etiology of alcoholism is complex. It includes a combination of environmental, psychological, and genetic factors.  

Environmental factors: Environmental factor can cause the development of alcoholism. Individuals who grow up in homes where alcohol is available, or heavy drinking is normal can be more likely to have alcoholism. Stressful life events like loss, trauma, or relationship problems can also elevate the risk of alcoholism. 

Genetic factors: Genetic factors can cause the development of alcoholism. Individuals who have a family history of alcoholism are at a higher risk of development of alcoholism than those individuals who do not have such a history. Many studies have identified some specific genes which can be linked to alcoholism. This can include the genes which are related to the metabolism of alcohol and genes which are related to the brain function. 

Psychological factors: Psychological factors like anxiety, depression, or low self-confidence can lead to the development of alcoholism. Individuals who may use alcohol to overcome with negative emotions or to get rid of mental health issues. Specific personal traits like sensation or impulsivity seeking can elevate the risk of alcoholism.  

Genetics

Prognostic Factors

The prognosis factors of alcoholism may vary based on many factors like severity of condition, the present of mental health or physical conditions along with alcoholism, and motivation and commitment of individuals to recovery.  

Severity of alcohol use disorder: Individuals who have moderate AUD may have a good prognosis than those who have severe alcoholism. Severe alcoholism is linked with severe mental and physical health problems. It may need more intensive treatment.  

Co-occurring conditions: Individuals who have mental health or physical conditions like depression or liver disease along with alcoholism may have a pooper prognosis than who have not such conditions.  

Family history: Individuals who have a family history of alcoholism may have a poorer diagnosis than those who do not have any history. They may be more susceptible to recurrence and need continued treatment to recover.  

Motivation and commitment to recovery: Individual who is more motivated and committed to recovery may have a good prognosis than those individuals who are not. Support from friends, family and healthcare providers may help to maintain their motivation and commitment to reach to the goal. 

Age: Younger individuals may have a good prognosis than the old individuals with alcoholism. They have a few physical health problems and are more responsive to the treatment. Old individuals may need more social support and more motivation to address their drinking habits.  

Gender: Women have a good prognosis than men. This is because they are more prone to treatment and have less severe psychological and physical problems of alcoholism. Women may have some extra challenges like gender-specific barriers or stigma. 

Clinical History

When getting a clinical history of alcoholism, healthcare providers may ask for questions about the alcohol use of a person, related behaviors, and mental and physical history. 

Alcohol use: The quantity, the frequency, and duration of the drinking level of person. This may include questions about the type of alcohol drink and whether the person has memory loss or blackouts because of drinking. 

Consequences of alcohol use: Whether the individual has any negative problems related to the drinking, like legal issues, relationship, and work-related problems.  

Family history: Whether the individuals have any family history of alcoholism or other substance use.  

Physical health: Whether the individual has any physical health problems which are related to drinking habits like heart disease, liver disease, or gastrointestinal problems.  

Mental health: Individuals who have any mental health problems like anxiety, depression, or trauma, and any attempt of suicide.  

Treatment history: Individuals who have received alcoholism treatment, if yes, then how effective it was.  

Other substance use: Individuals who have used other substances like illicit drugs, tobacco, or prescription drugs. 

Physical Examination

A physical examination who has alcoholism may have some different symptoms which are associated with chronic alcohol use.  

Jaundice: Yellow skin and eyes because of liver damage.  

Enlarged liver or spleen: The liver can be enlarged because of the alcoholic hepatitis or fatty liver disease. 

Ascites: A fluid buildup in the abdomen because of liver damage.  

Palmar erythema: A red palms on he hands because of the liver damage. 

Spider angiomas: It is a small and spider-like blood vessel on the skin because of liver damage.  

Tremors: Shaking hands, specifically when doing some delicate task. 

Ataxia: It is a loss of coordination and unstable move because of damage to the cerebellum in the brain. 

Peripheral neuropathy: Numbness, tingling, pain in extremities because of nerve damage. 

Wernicke-Korsakoff Syndrome: A neurological condition caused by thiamine deficiency. The symptoms are confusion, memory loss, and difficulty in coordination. 

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

• Substance use disorders: Other substance use disorders like opioid or stimulants use disorders may have similar symptoms to alcoholism.  
• Mood disorders: Bipolar disorder or depression are mood disorders. They can occur along with alcoholism or have similar symptoms like changes in appetite or sleep, fatigue, or irritability. 
• Anxiety disorders: Anxiety disorders like social or generalized anxiety can occur along with alcoholism or have symptoms like agitation, restlessness, and panic attacks. 
• Personality disorders: Certain types of personality disorders, like borderline personality disorder, may have impulsivity and substance use. And unstable relationship. 
• Neurological disorders: Neurological disorders like Parkinson’s disease or Huntington’s disease can lead to symptoms like tremors, balance problems, and difficulty speaking. 
• Liver disease: Liver diseases like cirrhosis or hepatitis can lead to abdominal pain, jaundice, and fatigue, which may be mistaken for alcohol-related symptoms. 
• Metabolic disorders: Metabolic disorders like hypoglycemia or hypothyroidism can cause symptoms like fatigue, confusion, and depression. 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Treatment Paradigm  

Most individuals who have AUD can benefit from some treatment. Medical treatments include pharmacological treatments and psychological treatments like behavioral treatments. The combination of both treatments may have the best results. Support groups like alcoholics anonymous (AA) can be helpful for individuals who are having the treatment for AUD.  

Individuals who have AUD may need more comprehensive treatment. They can choose for intensive treatment by visiting a residential treatment center rehab facility. Treatment is highly organized in these facilities with different psychological treatments. Individuals can also take medications for detoxification to manage the withdrawal symptoms of alcohol and to treat AUD. 

Pharmacological treatment 

• Disulfiram: Disulfiram causes unpleasant symptoms like skin flushing and nausea when it is consumed with alcohol. Be aware that the drinking habit can trigger unpleasant effects will make the individual to avoid alcohol. 
• Naltrexone: Naltrexone drug blocks the receptors in the brain, which produce the pleasant feelings when consuming alcohol. It may also reduce the urge to drink alcohol and help to reduce the overall consumption of alcohol. 
• Acamprosate: This medication helps individuals to avoid alcohol. It works on several brain systems to decrease the craving, specifically during the initial stages of quitting.  

Behavioral therapies 

• Cognitive behavioral therapy (CBT): CBT can help to individuals to identify the emotions and situations that can trigger the excessive alcohol consumption. This treatment teaches the effective coping mechanisms like managing stress and alter the patterns which lead to drinking. CBT may provide one-on-one sessions with a therapist. 
• Marital and family counseling: It includes some activity with spouses and other family members to improve the relationship. This treatment can repair and strengthen the family bonds. Research suggests that robust family support via family treatment can be helpful to individuals who avoid alcohol.  
• Motivational enhancement therapy: It is a type of treatment that helps individuals to enhance and reinforce their motivation to quit the drinking habits. It includes four sessions, which are conducted over a brief period. This first stage of therapy centers to identify the advantages and disadvantages of treatment. Then, the therapists collaborate with the individual to create a plan to change the drinking pattern. The next session concentrate on increasing the self-awareness and assurance and to develop the necessary skills. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Future Trends

Media Gallary

References

https://medlineplus.gov/alcoholusedisorderaudtreatment.html 

https://emedicine.medscape.com/article/285913-overview#a6