What Is Alcohol Dependence?

From the desk of Adedapo Oduwole, MD

What Is Alcohol Dependence?

Alcohol dependence is a chronic relapsing disorder of the brain characterized by the harmful consequences of repeated alcohol use in a compulsive pattern that results in significant dysfunction and problems in multiple areas of life. Problems typically encountered as the result of excessive alcohol consumption include run ins with the law (i.e. DUIs, public intoxication charges, drunk & disorderly charges, etc.), financial problems that come about from spending excessive amounts of one’s money to buy alcohol, relationship breakdowns, poor work performance or missing work all together, and health concerns.

Alcohol dependence is a highly prevalent and costly disorder, affecting from 10 to 20 percent of the population with males being twice as likely to use alcohol than females. The cost of excessive alcohol consumption annually in the United States is more than $150 billion in both direct and indirect figures. Each year there are more than 25,000 deaths in the US that are directly attributed to alcohol use in addition to more than 2 million injuries. Twenty percent of all health care costs come as a result of treating alcohol related accidents.

Familial Patterns

Alcohol dependence often has a familial component. It is estimated that 40 percent of the risk of becoming alcohol dependent is explained by genetic influence. The risk is four times greater when a close relative has an alcohol problem than in a family where no member struggles with alcohol use issues. Among twins, the risk for developing alcohol problems is greater for monozygotic (identical) twins than for dizygotic (fraternal) twins when at least one parent has alcohol issues. Among children who were adopted shortly after birth by parents that were non-alcoholics, but who had at least one biological parent that struggled with alcohol, the risk is still fourfold that they will develop alcohol related issues somewhere in their lives. The mode of heredity is both polygenetic and hetero-genetic.

A person’s environment plays a 60 percent role in the likelihood that they will develop alcohol use problems.

Co-Morbidity and the Course of Alcohol Dependence

Individuals with alcohol dependence issues are at an increased risk for developing major depressive disorder (MDD), bipolar disorder, and other substance related disorders. In adolescents who use, the prospect of being diagnosed with having a conduct disorder is greatly heightened and the same holds true for adults in terms of being labeled with anti-social personality disorder. In many cases, regardless of the psychiatric condition or diagnosis, there is a great propensity to use alcohol in an attempt to drive away the symptoms, whether it is symptoms of depression, anxiety, or the hallucinations that come with schizophrenia or bipolar disorder. It is often the case that alcohol makes the underlying psychiatric disorder more difficult to treat and vice versa.

Among individuals with the diagnosis of alcohol dependence, only 5 percent ever experience severe complications typically associated with withdrawal such as seizures, shakes, or delirium. The fact of the matter is that even highly skilled physicians can never tell which 5 percent will be affected by these conditions.

Repeated intake of large quantities of alcohol can affect nearly every organ system in the human body, especially the gastro-intestinal tract, the cardiovascular system, and the central and peripheral neuronal system. Gastro-intestinal conditions include gastritis, stomach or duodenal ulcers, and in about 15 percent of alcoholics cirrhosis of the liver and pancreatitis. Research also bears out that cancer of the esophagus, stomach, and other parts of the gastro-intestinal tract are more likely to occur. One of the more common general medical conditions seen in heavy alcohol users is that of low-grade hypertension.

Other medical conditions that may be evidenced in those who use alcohol to excess is peripheral neuropathy which displays itself in the form of muscular weakness, parasthesia, and a decrease in peripheral sensations. A most persistent central nervous system (CNS) affect includes cognitive deficits, severe memory impairment, and degenerative changes in the cerebellum which results in poor balance and coordination of movements. Another devastating CNS affect is the relatively rare alcohol-induced amnestic condition known as Wernicke-Korsakoff syndrome (WKS). In Wernicke-Korsakoff the brain atrophies (shrinks) as a result of the alcohol intake with the result being a severe impairment in the short-term memory, or recall.

Complications indigenous to men that result from alcohol use include erectile dysfunction and decreased testosterone levels. In women, menstrual irregularities, spontaneous abortions, and difficult pregnancies are all situations that may arise, in addition to fetal alcohol syndrome that may occur in the child she bears. Additionally, alcohol use to excess can suppress the immune system mechanism and predispose individuals to increased risk of infections and various cancers.

Treatment

Follow up studies of individuals who have been heavy users of alcohol and who have entered treatment show that nearly 70 percent have been able to remain abstinent for at least one full year. Among those who have completed a treatment program and who may be lower functioning or homeless, a full 60 percent have been able to stay clean for 3 months and 45 percent for at least one year. Even those individuals who have been alcohol dependent but never sought treatment have been able to achieve long-term sobriety 20 percent of the time. None the less, most individuals who have had trouble with alcohol do need some type of program to help get them clean and the statistics listed indicate the successful outcomes associated with receiving treatment.

Alcohol dependence treatment typically comes in one of two forms: (1) Detoxification and (2) rehabilitation. Detoxification (detox) is the removal of toxins, such as alcohol, from the body. This usually requires inpatient hospitalization where medications such as benzodiazepines are used to help ease the patient through the detox process. In some cases anti-convulsants may be used for this purpose. On average, it takes 3-7 days to complete this method of treatment.

In many cases rehabilitation comes after the detoxification process and is indicated as a step-down program requiring less intensive supervision of the client. In the case of some long-term rehab programming such as a 90 or 120 day residential program, the client must be detoxed and medically stable as these programs have little or no medical staff on premises.

Regardless of the length of a program, there is always a method for achieving sobriety and maintaining it. Programs may be 12-step focused, faith based, therapy based, or utilize a combination of these in order to help the client remain clean. In therapy based programming cognitive behavioral therapy is the most effective method of treatment, however the client will also receive treatment with regards to psychosocial issues and self-help meetings should also be encouraged. In many cases the individual will still need the help that medications can contribute in combating the desire to use alcohol. Medications such as antabuse, acamprosate and naltrexone serve this purpose.

Personal Treatment Philosophy of Dr. Oduwole

I believe that treatment for alcohol dependence should consist of both medication management and psychosocial counseling, whether that counseling be in a group setting or one-on-one with a personal therapist. Professional research bears out time and time again that both modes of treatment are more effective in combination than just one or the other alone. Additionally, each client should have individualized treatment plan tailored to his or her own needs as there are no two similar alcohol dependent people. Each client inherits characteristics that predispose them to alcohol dependence and environmental influences add further complexities to the presentation of the illness. Furthermore, each one likely has a different reason for being in treatment with different goals not just for remaining abstinent, but for the rest of their life. Finally, a good support system is necessary. A physician and a therapist that believe in the client are essential, but when the client is away from both of them it is similar to an amateur gymnast performing acrobatic stunts without a safety net– There is GREAT POTENTIAL FOR FALLING. A person in recovery will need the help of family and friends, a sponsor, and even his or her church congregation. Leaving a person with an alcohol dependence issue to fend for themselves is likely to result in a relapse. Outside support is essential for the person recovering from alcohol dependence.