Drugs, Behaviour, and Modern Society

Chapter 9

Chronic Alcohol Abuse and Alcoholism

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 Alcoholism: Stereotypes, Definitions,
and Life Problems
• Alcoholism—a multidimensional condition that is
typically defined in terms of four major criteria:
1. Problems associated with a preoccupation with drinking
2. Emotional problems
3. Vocational, social, and family problems
4. Physical problems

• Not all criteria must be met for alcoholism to be

diagnosed.

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 Alcoholism: Stereotypes, Definitions,
and Life Problems
• Symptomatic drinking is a pattern of alcohol
consumption aimed at reducing stress and anxiety.
• NIAAA guidelines for “at risk” or “heavy” drinking
– More than four drinks on any day, and more than
14 drinks per week (for men)
– More than three drinks on any day and more than
seven drinks per week (for women)

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 Alcoholism: Stereotypes, Definitions,
and Life Problems
• About 40% of individuals who meet the
criteria for alcohol dependence will have one
or more alcohol-induced depressive
episodes.
• Neuroimaging using CT and MRI brains:
– Has revealed a consistent link between heavy
drinking and physical shrinkage of brain matter

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 Alcoholism: Stereotypes, Definitions,
and Life Problems
Hiding the Problems: Denial and Enabling
•Enablers:
– Individuals whose behaviour consciously
or unconsciously encourages another
person’s continuation in a pattern of
alcohol or other drug abuse.

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Alcohol Abuse and Alcohol Dependence:
The Health Professional’s Perspective
• The DSM-5 (2013):
– Combines the diagnoses of alcohol abuse and
alcohol dependence into one new diagnosis: alcohol
use disorder
• Based on the same behavioural criteria previously
identified with alcohol abuse and alcohol dependence…
– With the exception of “legal problems”, which has
been dropped, and
– The criterion of “craving”, which has been added.

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Alcohol Abuse and Alcohol Dependence:
The Health Professional’s Perspective
• The first syndrome, referred to as alcohol
abuse, is characterized as either:
1. The continued use of alcohol for at least one
month
– Despite the knowledge of having persistent physical,
social, or occupational problems that have become
associated with alcohol use, and
2. Recurring use of alcohol in physically hazardous
situations

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Alcohol Abuse and Alcohol Dependence:
The Health Professional’s Perspective
• The second syndrome, referred to as alcohol
dependence, is characterized as alcohol abuse that
involves any three of the following seven circumstances:
1. Consuming alcohol in greater amounts or over a longer period
than the person intends
2. A persistent desire, or one or more unsuccessful attempts, to cut
down or control drinking
3. A great deal of time spent drinking or recovering from the effects
of drinking

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Alcohol Abuse and Alcohol Dependence:
The Health Professional’s Perspective
4. Alcohol consumption continuing, despite knowledge that
drinking either causes or exacerbates recurrent physical or
psychological problems
5.Major social, occupational, or recreational activities given up or
reduced because of alcohol
6.Marked tolerance or the need to drink more than before to
achieve previous levels of intoxication
7.Symptoms of alcohol withdrawal or the consumption of alcohol to
relieve or avoid withdrawal symptoms

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 Physiological Effects of Chronic
Alcohol Use
Tolerance and Withdrawal
•Alcohol consumption over a period of time will result in a
tolerance effect.
•Physical withdrawal effects are classified in two clusters
of symptoms:
– Alcohol withdrawal syndrome
– Delirium tremens

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 Physiological Effects of Chronic
Alcohol Use
Tolerance and Withdrawal
•Alcohol withdrawal syndrome:
– The more common of two general reactions.
– Characterized by physiological discomfort, seizures, and sleep
disturbances

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 Physiological Effects of Chronic
Alcohol Use
Tolerance and Withdrawal
•Delirium tremens (DTs):
– The less common of two general reactions
– Characterized by extreme disorientation and confusion, fever,
hallucinations, and other symptoms

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 Physiological Effects of Chronic
Alcohol Use

Liver Disease
•Alcoholic hepatitis:
– A disease involving inflammation of the liver as a result of
chronic alcohol abuse

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 Figure 9.1

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 Physiological Effects of Chronic
Alcohol Use
Cardiovascular Problems
•About 1 in every 4 alcoholics develops cardiovascular
problems owing to the chronic consumption of alcohol.
Cancer
•Chronic alcohol abuse is associated with the increased
risk of several types of cancers:
– In particular, cancers of the pharynx and larynx
– Nearly 50% of all such cancers are associated with
heavy drinking.

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 Physiological Effects of Chronic
Alcohol Use
Dementia and Wernicke-Korsakoff Syndrome
•Alcoholic dementia:
– Chronic alcohol abuse produces cognitive deficits such
as difficulties in problem solving and memory
•Wernicke-Korsakoff syndrome:
– Characterized by disorientation, cognitive deficits,
amnesia, and motor difficulty
– Confabulation is the tendency to make up elaborate
past histories to cover the fact that long-term memory
has been impaired

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 Physiological Effects of Chronic
Alcohol Use
Fetal Alcohol Syndrome Disorder (FASD)
•A serious condition involving mental retardation
and facial-cranial malformations in the offspring of
an alcoholic mother
– Alcohol is teratogenic – capable of producing
specific birth defects

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 Patterns of Chronic Alcohol Abuse
Gender Differences in Chronic Alcohol Abuse
•Among persons aged 18 or older:
– Men out number women in the incidence of binge drinking by
about two to one, and heavy alcohol use by about three to one.

•Overall, women are more vulnerable to alcohol-related

organ damage
– Unknown whether high risk results from differences in the
pattern of drinking or from differences in the way alcohol is
processed in a woman’s body

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 Patterns of Chronic Alcohol Abuse

Alcohol Abuse among the Elderly

•It has been estimated that approximately 9% of
the elderly have alcohol problems, described by:
– Consuming 4 or more drinks in a single day, or more
than 30 drinks per month

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 Patterns of Chronic Alcohol Abuse
The Family Dynamics of Alcoholism: A
Systems Approach
•Examines the complex interacting relationships
among individuals, family, friends, and community
•The concept of co-dependency has helped shed
light on the specific effects of alcoholism on
spouses and other family members

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 Patterns of Chronic Alcohol Abuse

Children of an Alcoholic Parent or Parents

(COAs)
•Carry an increased risk of becoming alcoholic as
a result of a vulnerability toward alcoholism that is
genetically or environmentally based, or both

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 The Genetics of Alcoholism
• Studies of adoptions and twins have provided
information about the relative influence of
genetics and environment on the
development of alcoholism.
• A distinction has been made between a male
or female alcoholic with drinking problems
occurring late in life (Type 1) and an alcoholic
with drinking problems occurring earlier in life
(Type 2).

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 Table 9.2

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 The Genetics of Alcoholism

• The Type 2 subgroup:

– Appears to have a greater genetic
component in the inheritance pattern

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The Concept of Alcoholism as a Disease

• The majority position with respect to

alcoholism:
– It should be considered a disease
– Alcoholics should be treated rather than punished
• Since 1957, the American Medical Association
has defined alcoholism as a disease.
– Other health organizations have adopted a similar
position.

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 Figure 9.2

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The Concept of Alcoholism as a Disease
• A study in 2000 found that 94% of a group of
primary care physicians failed to make a
correct diagnosis of early-stage alcohol abuse
when presented with symptoms typical of this
condition.
• Only 1 out of 5 physicians, considered
themselves “very prepared” to diagnose
alcoholism in the first place.

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Approaches to Treatment for Alcoholism

• Three psychosocial approache sto alcoholism

treatment:
1.Cognitive behavioural coping skills therapy, oriented toward
correcting poor self-esteem and distorted, self-defeating thinking
2.Motivational enhancement therapy, helping to improve one’s
readiness to quit drinking
3.Twelve-step facilitation therapy, designed to educate clients with
the philosophy of Alcoholics Anonymous and encourage their
participation.

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Approaches to Treatment for Alcoholism

Biologically Based Treatments

•The earliest biologically based treatment was
the introduction of disulfiram
– Disulfiram:
• A medication that causes severe physical reactions and
discomfort when combined with alcohol.
• Brand name is Antabuse

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Approaches to Treatment for Alcoholism
– Naltrexone:
• A long-lasting opioid antagonist for the treatment of
alcoholism.
• Brand name is ReVia

– Nalmefene:
• A long-lasting opioid antagonist for the treatment of
alcoholism
• Brand name is Revex

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Approaches to Treatment for Alcoholism
– Acamprosate:
• A GABA-related drug for the treatment of alcoholism.
• Brand name is Campral

– Ondansetron
• A serotonin-related drug for the treatment of alcoholism
• Brand name is Zofran

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Approaches to Treatment for Alcoholism

Alcoholics Anonymous (AA)

•A worldwide organization devoted to the
treatment of alcoholism:
– Involves self-help groups and adherence to AA
principles, which include absolute abstinence from
alcohol

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Approaches to Treatment for Alcoholism
S Recovery
•Objection to certain aspects of the AA philosophy has
promoted the growth of other self-help organizations, such
as:
– Moderation Management (MM)
– SMART Recovery

•They assume that people do not need to believe they are

“powerless over alcohol” or submit to “a Power greater
than ourselves”.

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 Chronic Alcohol Abuse and
Alcoholism in the Workplace
• Corporations and other large organizations
have instituted employee assistance programs
(EAPs)
• Unions have instituted member assistance
programs (MAPs)
– To help workers with problems of alcohol abuse or
other forms of drug abuse

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