Alcoholism

Alcohol dependence is characterised by craving, tolerance, a preoccupation with alcohol and continued drinking in spite of harmful consequences (e.g, liver disease or depression caused by drinking).

• continued hazardous and harmful drinking can result in alcohol dependence.
• alcohol dependence is also associated with increased criminal activity and domestic violence, and an increased rate of significant mental and physical disorders

ICD-10 defines dependency as:

“a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.”.

In earlier disease-classification systems this has been referred to as ‘alcoholism’.

Alcohol use disorder (AUD) was estimated to affect approximately 18% of the general population lifetime and 5% annually (3)

• DSM-5 definition of alcohol use disorder (AUD) combined DSM-IV alcohol abuse and dependence symptoms (4)
• estimated that almost 20% of adult patients in the emergency rooms suffer from AUD and that the incidence of alcohol withdrawal syndrome (AWS) in patients admitted to surgical Intensive Care Unit (ICU) varies from 8 to 40%, and seems to be associated with infectious complications and a higher mortality rate
• up to 50% of AUD patients experience withdrawal symptoms, a minority of whom requires medical treatment

Griffith Edwards and Gross(1976) defined some simple markers of alcoholism. These are:

• dependent drinkers have a narrow repertoire of alcohol consumption: alcohol is used to avoid withdrawal symptoms
• drinking overtakes the individual's activities to the exclusion of everything else, leading to theft, begging and borrowing
• withdrawal symptoms include trembling, fear, insomnia, nightmares, sweating and hallucinations.
• tolerance develops so that the dependent drinker consumes quantities which might make non-drinkers unconscious
• dependent drinkers know that they cannot control their alcohol use
• there is a high tendency to relapse after abstinence

Alcohol withdrawal symptoms occur within 12 hours of the last drink.

Alcohol abstinence improves prognosis across all stages of portal hypertension in alcohol-related cirrhosis, including in patients who have already progressed to high-risk portal hypertension (5)

Reference:

• (1) NICE (February 2011). Alcohol-use disorders - Diagnosis, assessment and management of harmful drinking and alcohol dependence
• (2) NICE (June 2010). Alcohol use disorders
• (3)Mirijello A et al. Identification and Management of Alcohol Withdrawal Syndrome Drugs. 2015 Mar; 75(4): 353–365.
• (4)American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th. Arlington: American Psychiatric Association; 2013
• (5) Hofer BS et al. Alcohol abstinence improves prognosis across all stages of portal hypertension in alcohol-related cirrhosis. Clin Gastroenterol Hepatol. 2022 Dec 5:S1542-3565(22)01113-2.