Alcoholism is a chronic disease
Alcoholism is a progressive and chronic disease that includes controlling drinking, using alcohol even though it causes problems, having physical dependence with alcohol, or having withdrawal symptoms when one tries to cut back or stop consuming alcohol. One can have a problem with alcohol and not have it progressed to alcoholism. That is called problem drinking which means one drinks too much causing repeated problem in their life. According to the Mayo Clinic (2012), binge drinking is a pattern where a male consumes five or more drinks in a row, or a female drinks at least four drinks in a row. Binge drinking can lead to the same health risks associated with alcoholism (Mayo, 2012). Not being able to stop drinking or cut back and denying you have a problem is a few of the things that come with alcoholism Criteria for alcoholism based on the DSM V are an individual meeting any two of the eleven criteria during the same twelve month period.
Examples of these criteria include: a persistent desire or unsuccessful efforts to cut down or control alcohol use, craving or strong desire or urge to use alcohol, and important social, occupational or recreational activities are given up or reduced because of alcohol use (NIH, 2013b). As for ICD criteria, an individual must experience certain criteria as well. ICD criteria require an individual to experience three or more of the criteria occurring together for at least 1 month or if less than 1 month, occurring together repeatedly within a 12-month period. Examples of these criteria include: “Difficulties in controlling drinking in terms of onset, termination, or levels of use; drinking in larger amounts or over a longer period than intended; or a persistent desire or unsuccessful efforts to reduce or control drinking, Need for significantly increased amounts of alcohol to achieve intoxication or desired effect; or markedly diminished effect with continued use of the same amount of alcohol, or Important alternative pleasures or interests given up or reduced because of drinking” (Hasin, 2013).
According to the article, Alcohol Consumption and Cancer Risk (2011), there is a dramatic link between alcohol and cancer. “Heavy alcohol consumption ( ≥4 drinks/day) is significantly associated with an increased risk of about 5-fold for oral and pharyngeal cancer and esophageal squamous cell carcinoma, 2.5-fold for laryngeal cancer, 50% for colorectal and breast cancers, and 30% for pancreatic cancer” (Pelucchi, Tramacere, Boffetta, Negri, & Vecchia, 2011). Evidence proves that even one drink per day increases the risk for pharyngeal or oral cancer by 20% and 30% for esophageal squamous cell carcinoma. Breast cancer has an increased risk of occurrence with three to six drinks a week. When an individual exposes themselves to both alcohol and tobacco, there is a greater increase in oral and pharyngeal cancer risk.
Alcohol also causes an increase in head and neck cancer when it is used alone (not used in conjunction with tobacco). “Restricting alcohol to limits indicated by the European Code Against Cancer would avoid nearly 90% of alcohol-attributable cancers and cancer deaths in men and over 50% of cancers in women” (Pelucchi, Tramacere, Boffetta, Negri, & Vecchia, 2011). This article provides great evidence of excessive alcohol being linked to further health risks for individuals who indulge over the recommended amounts. A person suffering from alcoholism has many outer appearance changes throughout their life. Someone suffering from alcohol withdrawal may experience nausea, sweating, hand tremors, visual hallucinations, or seizures. These are all very common symptoms associated when an alcohol dependent person goes through withdrawal. Not only do these physical symptoms occur, but psychological symptoms also occur. Examples of psychological symptoms include depression, anxiety, irritability, restlessness, or insomnia. Both the physical and psychological symptoms can be visible from an outsider’s perspective.
An alcohol dependent person may not experience withdrawal symptoms if they are taking in enough alcohol on a daily basis that meet their required needs to feel well. Though they may not have the withdrawal symptoms, they do have physically visible symptoms from their excessive alcohol intake. Symptoms include facial redness/flushing of the skin, xerosis, dull skin tone, follicular hyperkeratosis, gingivitis, tooth decay, black hairy tongue, and weight gain. The most common though include dehydration of the skin and bloating in the abdomen or face (Drink Aware, 2014). Drinking too much alcohol deprives the skin from important vitamins and nutrients. Over time, losing these nutrients from excessive drinking can cause permanent damage from frequent flushing and redness of the skin. Facial and abdominal bloating occurs when the person experiences dehydration from the excess about of alcohol intake (Drink Aware, 2014).
Prevalence of lifetime alcohol use by age and gender graph was reported by the National Institute on Alcohol Abuse and Alcoholism (2013c): males age 18-24- 70% and women 55%, males age 25-34- 82% and women 65%, males age 35-44- 82% and women 63%, males age 45-55- 80% and women 55%, and males age 55 + 71% and women 39% (NIH, 2013c). According to the data from the National Household Survey, most Americans had at least one drink of alcohol by late adolescence. Among men, 70% to 83% reported consuming alcohol on at least one occasion during their lifetime, as compared to 39% to 66% of women. The prevalence rate of lifetime alcohol use among men is highest among those aged 25 to 55 and lowest among the 18 to 24 and 55 or older age groups. Similar findings were found for women, although they reported lower rates than men. The rate of lifetime alcohol was lowest among women ages 55 or older. The largest gender difference was noted among the 55 years or older age group, with males drinking more.
The smallest gender difference was between 18 to 24 years old (NIH, 2013c). Alcoholism results from the complex interaction of genetic, social, and environmental factors. Alcohol has widespread effects on the brain and can affect nerve cells, brain chemistry, and blood flow within the frontal lobes. Neurotransmitters are affected by long-term use of alcohol. Neurotransmitters are released when alcohol is consumed, which produce euphoria and a sense of well-being. “Chronic exposure of the brain to alcohol is thought to result in long-term adaptive changes that initially produce increased reinforcement for alcohol use and over time progress to withdrawal and negative affective states, so that regular alcohol use is required to feel normal” (Chung & Pittman, 2013) Being dependent on alcohol is often associated with psychiatric disorders, such as schizophrenia, depression, or PTSD. Genetic factors are believed to play a role in alcohol abuse.
The New York Times (2013), believe the amygdala, part in the brain responsible for controlling cravings, has been reported to be smaller in individuals with family history of alcoholism (TNYT, 2013). There are also many social and environmental factors that contribute to the development of alcohol abuse or alcoholism. There are mass marketing of alcohol on television, billboards, and gas stations. Marketing tends to increase the number of alcohol sales and in turn increase chance of alcohol abuse among individuals. Many young individuals are pressured by friends or even family to begin drinking at a young age. Drinking at a young age greatly increases chances of that individual to suffer from alcoholism in the near future. During the general assessment of a person suffering from alcoholism, the nurse is to first gather accurate data regarding their drinking patterns.
The nurse must ask the question, “Do you sometimes drink beer, wine, or other alcoholic beverages?” If the person states yes, then the nurse asks “How many times in the past year have you had five or more drinks in a day?” This will help the nurse gather important data regarding excessive alcohol consumption. The next step is to tell the patient to decrease the amount of alcohol that is being consumed since the chance of It is also important to ask about their life style, family, and relationships. The person may be experiencing depression or anxiety if they have lost family support because of their addiction. If this person is experiencing withdrawal symptoms during the assessment, the nurse should plan to provide comfort measures for this patient. The patient may also be very agitated, embarrassed, or not level headed, since alcohol has these effects on an individual.
By simply looking at the patients’ appearance, the nurse should be able to determine if the alcohol has caused further damage to the body’s organs. For example, if the liver is failing, the person may experience jaundice. Focusing the assessment around the use of the alcohol and effects it has on his or her life will be of most concern. The patient should have a full lab workup to determine if further damage has occurred to this patient’s health. The nurse can also provide appropriate resources for help, such as AA meetings, rehab, or family counseling, which will be beneficial for the patient. Drinking too much can take a serious toll on one’s health. Alcohol can affect a person brain, heart, liver, pancreas, immune system, and can increase the risk for cancer.
According to the National Institute on Alcohol Abuse and Alcoholism (2013a), alcohol interferes with the brain’s communication pathways. These disruptions can change mood and behavior. These changes can also make it harder to think clearly and move with coordination (NIH, 2013a). The heart can be affected with cardiomyopathy which is stretching and drooping of heart muscle. Arrhythmias, stroke, and high blood pressure can also occur from over using alcohol. Research by the NIH (2013a), alcohol can inflame the liver and cause steatosis or fatty liver, alcoholic hepatitis, fibrosis, and or cirrhosis. The pancreas produces toxic substances that can eventually lead to pancreatitis (NIH, 2013a). Pancreatitis is inflammation and swelling of the blood vessels in the pancreas that prevents proper digestion. The immune system is weakened. Chronic drinkers are more likely to contract diseases like pneumonia and tuberculosis than people who don’t drink.
Chronic alcohol consumption increases risk for cancers such as mouth, esophagus, throat, liver, and breast Alcohol pharmacokinetics includes absorption, distribution, and metabolism. After oral absorption, alcohol is absorbed from the duodenum by diffusion (Ramchandani, 2009). The rate depends on the volume of alcohol consumed (the less concentrated the slower rate of absorption), rate of drinking (faster you drink the faster the absorption), food, and gastric metabolism. The distribution of alcohol is into total body water. There are also gender differences in body. Women have a lower proportion in total body water compared to men. Metabolism of alcohol occurs primarily in the liver in a two-step process. As researched by Ramchandani (2009), the first step, alcohol is oxidized to acetaldehyde by the enzyme alcohol dehydrogenase or ADH. In the second step, acetaldehyde is converted to acetate by the enzyme aldehyde dehydrogenase.
Then there is alcohol pharmacodynamics (Ramchandani, 2009). Alcohol is a CNS depressant. Its stimulatory effects result from depression of inhibitory control mechanisms in the brain. Characteristic responses to alcohol include euphoria, impaired thought processes and decreased mechanical efficiency. More than just a doctor is needed for the treatment of alcoholism. Alcoholism counselors, social workers, psychologists, and family therapists are a few others that may be involved. There are three stages in treating alcoholism. The first is to make sure the person is medically stabilized. Next, they must undergo a detoxification process which is then followed by long-term abstinence and rehabilitation.
According to Cunha (2012), the most common medication in treating alcoholism is disulfiram (Antabuse). It interferes with alcohol metabolism resulting in a metabolite that makes the person nauseated and very uncomfortable when consuming alcohol (Cunha, 2012). If they stop taking this they can implant a device under the skin so they have to continuously take it without the freedom of being able to stop it. Other medications used are naltrexone (ReVia), acamprosate (Campral) and a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) (Cunha, 2012). Alcohol withdrawal is treated by oral or IV hydration along with medications. According to Cunha (2012), the most common medication groups used in treating alcohol withdrawal symptoms are benzodiazepines, which include lorazepam (Ativan), diazepam (Valium), and chlordizepoxide (Librium) (Cunha, 2012). Any person that is being treated for alcoholism should also receive thiamine (vitamin B1). The thiamine levels are usually low and if deficiency occurs it could lead to Wernicke’s encephalopathy.
The detoxification stage involves stopping the alcohol consumption. This usually occurs in an inpatient setting and will require extensive support. The medication will be given and then tapered off until no withdrawal symptoms are evident. This process lasts a few days to a week. Rehabilitation can be either a short term or long term residential program. These help those who are more severely dependent and need the help to develop skills not to drink and to work on ways to help them from relapsing. Short term programs are less than four weeks long where long term programs can last for a month to a year or more. There are also several effective individual treatments delivered by professional counselors in outpatient treatment clinics. These treatments include: twelve-step facilitation therapy, motivational enhancement therapy, and cognitive- behavioral coping skills.
There are also self-help programs which are: Alcoholics Anonymous (AA), women for sobriety, Rational Recovery, and SMART recovery (Cunha, 2012). These allow alcoholics to stop drinking and remain sober on their own. In conclusion, alcoholism is a very serious condition that sadly many people face in the world. There any many means of helping these patients, but only if the individual wants the assistance. Once the person is so alcohol dependent, they are in a state of denial and think that nothing is wrong with their habit, but the earlier we get them to understand their problems then the easier it is to help them through it. Alcoholism is not only a terrible disease itself, but it also leads to many other deadly diseases and illnesses.
The first priority to make a difference in the world is to educate the youth about alcohol, which will hopefully decrease the rates of alcoholism occurrences in the future. The effects of alcoholism which are physical and psychological can cause many problems that affect a person’s life in all aspects. Alcohol alters one’s brain, muscles, digestion process, and other disorders that affect one’s health. It also can cause depression or changes in behavior that result in problems with their family, friends, and with themselves.
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Hasin, D. (2013). National Institute on Alcohol Abuse and Alcoholism. Classification of Alcohol
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http://www.mayoclinic.org/diseases-conditions/alcoholism/basics/definition/CON-20020866) National Institute on Alcohol Abuse and Alcoholism (NIH). (2013a). Alcohol’s Effects on the `Body. http://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body National Institute on Alcohol Abuse and Alcoholism. (NIH). (2013b). Alcohol Use Disorder.
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http://pubs.niaaa.nih.gov/publications/Social/Module1Epidemiology/Module1.html Pelucchi, C., Tramacere, I., Boffetta, P., Negri, E., & Vecchia, C. (2011). Alcohol Consumption and Cancer Risk. Nutrition & Cancer, 63(7), 983-990. doi:10.1080/01635581.2011.596642.