Alcoholism

Alcoholism

Definition

• Alcoholism and alcohol abuse

o Regular and excessive use of alcohol with concomitant social, interpersonal, legal, occupational, and/or physical problems or

o Repeated use in hazardous situations such as driving

• Alcohol dependence

o Repeated alcohol-related difficulties in at least 3 areas of functioning that cluster together over any 12-month period

o Regular use of alcohol has resulted in a state of physiologic tolerance.

Symptoms & Signs

• Most patients with alcoholism do not have dramatic physical symptoms.

o Instead present with psychosocial difficulties

 Marital difficulties

 Job problems (tardiness, absenteeism)

 Legal problems resulting from driving while intoxicated

o Patients may describe a host of difficulties but may deny that they have a problem with alcohol abuse.

o Denial is a characteristic symptom of alcoholism.

• "CAGE" questionnaire: any positive answer indicates a high probability of alcoholism

o Blackouts

 Episode of temporary anterograde amnesia associated with alcohol use

 Occurs in ~35% of drinkers

o Sleep disturbances

 Deficiency in rapid eye movement and deep sleep results in prominent and sometimes disturbing dreams later in the night.

o Sleep apnea

 75% of alcoholic men over age 60

 Relaxes muscles in the pharynx

o Impairment in judgment and coordination

 At least half of patients with physical trauma have evidence of substance-related impairment.

 In the U.S., 40% of drinkers have at some time driven while intoxicated.

o Peripheral neuropathy

 Chronic high doses of alcohol; occurs in 5–15% of alcoholics

o Cerebellar degeneration

1% of alcoholics

 Syndrome of progressive unsteady stance and gait often accompanied by mild nystagmus

2 Alcoholism

o Alcohol-induced mood disorder

 Intense sadness lasting for days to weeks in the midst of heavy drinking in 40% of alcoholics

o Alcohol-induced anxiety disorder

 Temporary severe anxiety in 10–30% of alcoholics

 Often begins during alcohol withdrawal

 Can persist for many months after cessation of drinking

o Alcohol-induced psychotic disorder

 Auditory hallucinations and/or paranoid delusions with a clear sensorium

• GI findings

o Esophagus and stomach

 Inflammation of the esophagus and stomach

 Epigastric distress

 GI bleeding

o Pancreas and liver

 Incidence of acute pancreatitis (~25 per 1000 per year) almost 3-fold higher than in the general population

 Repeated exposure to ethanol leads to:

 Fatty accumulation in the liver

 Alcohol-induced hepatitis

 Perivenular sclerosis

 Cirrhosis (15–20%)

 Chronic pancreatitis

• Cardiovascular findings

o Chronic heavy drinking

 Mild to moderate hypertension

 Cardiomyopathy

 One-third of cases of cardiomyopathy are alcohol induced.

 Atrial or ventricular arrhythmias, especially paroxysmal tachycardia

 Occurs after a drinking binge in individuals showing no other evidence of heart disease: "holiday heart"

• Genitourinary system changes; sexual function

o Acutely (modest alcohol dose: blood alcohol concentrations of ≤100 mg/dL)

 Increases sexual drive and decreases erectile capacity in men

o Chronic alcoholism in men

 Irreversible testicular atrophy with concomitant shrinkage of the seminiferous tubules, decreases in ejaculate volume, lower sperm count

o Repeated ingestion of high doses of ethanol by women

 Amenorrhea

 Decrease in ovarian size

 Absence of corpora lutea with associated infertility

 Spontaneous abortions

• Musculoskeletal findings

o Acute alcoholic myopathy

 Condition improves, but might not disappear with abstinence.

o Effects of repeated heavy drinking

 Alteration in calcium metabolism

 Lower bone density

 Increased risk for fractures and osteonecrosis of the femoral head

Alcoholism 3

• Alcohol-withdrawal syndrome

o Withdrawal symptoms generally begin within 5–10 hours of decreasing ethanol intake, peak in intensity on day 2 or 3, and improve by day 4 or 5.

o Anxiety, insomnia, and mild levels of autonomic dysfunction may persist to some degree for ≥6 months; may contribute to the tendency to return to drinking.