What is it?
Alcoholism is a condition resulting from excessive drinking of beverages that contain alcohol. Alcoholism, also known as alcohol dependence, is a disease that includes the following four symptoms:
Physical dependence--withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping drinking
Tolerance--the need to drink greater amounts of alcohol to get "high"
Craving--a strong need, or urge, to drink
Loss of control--Not being able to stop drinking once drinking has begun
Heavy drinking is widespread. According to the Office of National Statistics (2013), 34% of men and 28% of women drink above the recommended number of weekly units for sensible drinking, placing themselves at increased risk of future health or social problems, while one in 10 men in the UK and one in 20 UK women show signs of alcohol dependence - twice as many as are dependent on all forms of drugs, including prescription drugs.
The major health risks of alcoholism include liver disease, heart disease, certain forms of cancer, pancreatitis, and nervous system disorders. These conditions often develop gradually and may only become evident after long-term heavy drinking. Women also tend to develop health problems before men. The liver is particularly vulnerable to diseases related to heavy drinking, most commonly alcoholic hepatitis (inflammation) or cirrhosis (scarring of the liver).
Experts have defined a second problem, called alcohol abuse, as something different from alcoholism. The difference is that those who abuse alcohol do not have an extremely strong craving for alcohol, loss of control over drinking, or physical dependence. People who abuse alcohol can also develop the physical symptoms related to alcoholism, however. Alcohol abuse is defined as a pattern of drinking that results in particular situations, such as failure to fulfil work, school or home duties, or having recurring alcohol-related legal problems, such as arrests for driving under the influence of alcohol.
Laboratory tests can help diagnose a case of alcoholism but no single laboratory test or combination of tests has been shown to be ideal for screening or diagnosis. There are, however, some tests that are useful in evaluating patients:
- Gamma-glutamyl transferase (GGT)), a liver enzyme that is increased by heavy alcohol intake but also by other forms of liver disease
- Mean corpuscular volume (MCV), a measure of the size of red blood cells, which is increased by prolonged heavy drinking.
- Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST), enzymes that can indicate liver damage, which is often related to alcohol use
- Carbohydrate-deficient form of transferrin (CDT), a molecule involved in iron transport in blood. CDT is elevated in the blood of heavy drinkers but raised levels can also be found in a number of medical conditions. It is not useful as a screening test for alcohol abuse but may be useful in detecting those who have relapsed.
- A blood alcohol level (ethanol test) can be used to determine if a person has been drinking alcohol recently but does not diagnose alcoholism.
The GGT result is more useful than the MCV result as a “red flag” to raise the suspicion that the person is drinking too much. Both of these tests are relatively poor for screening or as diagnostic tests because conditions other than alcohol abuse or alcoholism can cause elevated levels within the bloodstream.
Physical examination also may reveal signs suggestive of alcoholism, such as evidence of injuries, a visible network of enlarged veins just under the skin around the navel (called caput medusae), fluid in the abdomen (ascites), yellowish-tone to the skin, decreased testicular size in men, and poor nutritional status.
Throughout the UK, specialist alcohol services are provided by the NHS, the private sector and through voluntary organisations. Some individuals will only need or want to learn to reduce or control their drinking while others will need to abstain from alcohol use. Alcohol services offer a wide range of interventions and treatments including brief interventions, motivational interviews, counselling, detoxification services and self help groups. Detoxification (alcohol withdrawal) can be provided in a number of settings including hospital wards, NHS alcohol treatment units, and residential services.
A variety of drugs can be used to treat alcoholism. Benzodiazepines (Valium or similar drugs) are sometimes used during the first days after drinking stops to help a patient safely withdraw from alcohol. These drugs are not used beyond the first few days, however, because they may be very addictive.
There are three oral medications that have been approved by the National Institute for Health and Care Excellence (NICE) to help people remain sober: disulfiram, naltrexone, and acamprosate. They are prescribed for those who have indicated their intention to abstain from alcohol but require some reinforcement. Disulfiram causes unpleasant symptoms such as nausea, vomiting, and flushing with any amount of drinking. Naltrexone blocks the "high" feeling a person may get from drinking but can cause severe withdrawal symptoms in people who are also dependent on opiates. Acamprosate helps reduce the craving for alcohol.
Just as there is no individual test for screening or diagnosing alcoholism, there is not one single drug that effectively treats alcoholism. In other words, no single drug is available that works in every case because body chemistries are slightly different and reasons for drinking are also different. Developing new and more effective drugs to treat alcoholism is a high priority for researchers.