ALCOHOL AND ALCOHOLISM

1. Costs the United States more than $100 billion a year; the most costlyhealth problem; includes costs
due to death and illness
a. Nevertheless, tobacco accounts for more loss of life. The best way to reduce long-term mortality is to
eliminate smoking.
b. Crime is the major cost issue for illegal drugs.
2. Alcohol is the most abused drug for all ages.
a. Approximately 10% of all adults (12 million people) are problem drinkers.
b. M > W
c. Most widely used illicit drug for teenagers and marijuana most widely used illicit drug.
3. Since 1980, per capita consumption of alcohol has declined. Binge drinking is becoming more
common. The proportion of heavy drinkers younger than 20 has increased.
4. Alcoholism rates are higher for the low-SES groups, but they recoversooner.
5. Alcohol use has been implicated in 15% of all auto accidents.
6. Alcohol use implicated in 50% of all
a. Auto accidents not involving a pedestrian
b. Auto accident deaths
c. Homicides (killer or victim)
d. Hospital admissions
7. Fetal alcohol syndrome (FAS)
a. The leading known cause of intellectual disability (Down syndrome is second)
b. Characterized by developmental and intellectual disability, craniofacial abnormalities, limb
dislocation
c. Consumption of large quantities of alcohol needed to produce FAS
8. Increasing evidence for genetic contribution
a. Concordance rates: MZ > DZ (MZ = 60%, DZ = 30%)
b. Marked ethnic-group differences: Asians, Jewish Americans, and Italian Americans much less likely
to develop alcoholism than Americans with northern European roots
c. Capacity to tolerate alcohol is the key (enzyme induction, lack of tyrosine kinase)
d. If biologic father was an alcoholic, the incidence of alcoholism in males adopted into nonalcoholic
families is equal to the incidence of alcoholism in sons raised by biologic alcoholic fathers.
e. Family history of alcoholism increases likelihood of major depression in offspring.
9. CAGE questions
a. Have you ever tried to Cut down on alcohol intake and not succeeded?
b. Have you ever been Annoyed about criticism concerning your drinking?
c. Have you ever felt Guilty about your drinking behavior?
d. Have you ever had to take a drink as an Eye-opener in the morning
to relieve the anxiety and shakiness?
10. Medical complications of alcohol abuse Cirrhosis, alcoholic hepatitis, pancreatitis, gastric or
duodenal ulcer, esophageal varices, middle-age onset of diabetes, gastrointestinal cancer,
hypertension, peripheral neuropathies, myopathies, cardiomyopathy, cerebral vascular
accidents, erectile dysfunction, vitamin deficiencies, pernicious anemia, and brain disorders,
including Wernicke-Korsakoff syndrome (mortality rate of untreated Wernicke is 50%;
treatment is with thiamine)
11. Chronic alcohol use can lead to cognitive decline.
12. Treatment issues
a. Most successful way to get person into treatment is to be referred by employer
b. Alcoholics Anonymous: largest source of alcohol treatment in U.S.
i. The original 12-step program. Grassroots movement
ii. Provides substitute dependency, social support, inspiration
and hope, and external reminders that drinking is
aversive. Meetings and sponsors
iii. Spiritual program
c. Al-Anon for family and friends: deals with codependence and enabling behaviors
13. Stages of behaviorial change
i. Precontemplation: unaware of problem
ii. Contemplation: aware of problem but ambivalent about action
iii. Preparation: first decision to change. Small steps taken.
iv. Action: change begins. Trial and error.
v. Maintenance: new behaviors practiced. Focus on relapse prevention.
vi. Relapse: efforts to change abandoned
Cycle may repeat until sobriety is established.
14. Pharmacologic treatments
a. Disulfiram (Antabuse)
i. Decreases alcohol consumption
ii. Interferes with aldehyde dehydrogenase and produces symptoms of nausea, chest pain,
hyperventilation, tachycardia, vomiting
iii. Should be used with psychotherapy (or 12-step program)

iv. Aversive conditioning