This Seminar was based on a comprehensive survey of PubMed between January, 2000, and March, 2007, excluding papers not published in English. The search terms used was “alcoholism”, in combination with “criteria”, “course” “treatment”, and “etiology”.
SeminarAlcohol-use disorders
Introduction
The alcohol-use disorders consist of alcohol dependence, alcohol abuse,1 and dependence or harmful use.2 These are common and potentially lethal disorders that mimic and exacerbate a wide range of additional medical and psychiatric conditions, and thereby shorten the lifespans of affected people by more than a decade.3 However, most people with alcohol-use disorders are hard to identity, since they are likely to have jobs and families, and present with general complaints such as malaise, insomnia, anxiety, sadness, or a range of medical problems.
Both primary-care physicians and specialists can help to screen for these disorders, institute brief interventions, and refer patients for more intensive care if needed. This paper presents a selective update of clinical developments regarding alcohol-use disorders that are relevant to practising physicians, and focus on skills that they already have or can easily acquire.
Section snippets
Epidemiology
Alcohol-use disorders are common in all developed countries, and are more prevalent in men than women, with lower, but still substantial rates in developing countries.3, 4, 5 Although rates of these disorders are lower in Mediterranean countries (eg, Greece, Italy, and Israel), and higher in northern and eastern Europe (eg, Russia and Scandinavia), they are responsible for a large proportion of the health-care burden in almost all populations.3, 4, 5
As many as 80% of men and 60% of women in
Criteria for screening and diagnosis
Clinicians should screen for unhealthy drinking (eg, more than three or four standard drinks per day), just as they counsel their patients for other risky behaviours such as being 10% overweight. A standard drink is defined as 8 g of ethanol in the UK and about 10 g in the USA. Both the US-based 4th Diagnostic and Statistical Manual (DSM-IV)1 and the 10th International Classification of Diseases (ICD10)2 describe alcohol dependence as the more severe condition, associated with major
Causes and origins
About 40–60% of the risk of alcohol-use disorders is explained by genes and the rest through gene–environment associations.43, 44 The environment includes the availability of alcohol, attitudes towards drinking and drunkenness, peer pressures, levels of stress and related coping strategies, models of drinking, and laws and regulatory frameworks.43, 44
Recent advances in our understanding of genes that operate through intermediate characteristics (or phenotypes) to affect the risk of alcohol-use
Treatment
Despite perceptions to the contrary, efforts to help patients decrease heavy drinking commonly result in changes in behaviours, and most patients with alcohol-use disorders do well after treatment.87, 88 About 50–60% of men and women with alcohol dependence abstain or show substantial improvements in functioning the year after treatment, and such outcomes are excellent predictors of their status at 3–5 years.26, 36, 37, 39, 89 Although anyone in treatment might do well, better outcomes are
Rehabilitation
The goals of rehabilitation for alcohol-use disorders are the same as for any chronic relapsing disorder: to help to keep motivation high, change attitudes toward recovery, and diminish the risk of relapse.3 Cognitive-behavioural steps can help people to change how they think about alcohol and its role in their lives (the cognitive component); learn new behaviours for development and maintenance of abstinence or diminished drinking; and avoid relapses.
The Alcoholics Anonymous programme offers
Conclusions
The criteria for alcohol dependence are reliable, patients face substantial morbidity and mortality, and resources are available to identify patients with unhealthy drinking or alcohol-use disorders, and to offer treatment. Treatment can include motivational interviewing to help people to evaluate their situations, brief interventions to facilitate more healthy behaviours, cognitive-behavioural therapies, and the judicious use of drugs to improve outcomes for alcohol-use disorders.
Search strategy and selection criteria
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