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"Alcoholic" redirects here. Alcoholism_sentence_0

For alcoholic beverages, see alcoholic drink. Alcoholism_sentence_1

For the song by Starsailor, see Alcoholic (song). Alcoholism_sentence_2


Other namesAlcoholism_header_cell_0_1_0 Alcohol dependence syndrome, alcohol use disorder (AUD)Alcoholism_cell_0_1_1
SpecialtyAlcoholism_header_cell_0_2_0 Psychiatry, clinical psychology, toxicology, addiction medicineAlcoholism_cell_0_2_1
SymptomsAlcoholism_header_cell_0_3_0 Drinking large amounts of alcohol over a long period, difficulty cutting down, acquiring and drinking alcohol taking up a lot of time, usage resulting in problems, withdrawal occurring when stoppingAlcoholism_cell_0_3_1
ComplicationsAlcoholism_header_cell_0_4_0 Mental illness, delirium, Wernicke–Korsakoff syndrome, irregular heartbeat, cirrhosis of the liver, cancer, fetal alcohol spectrum disorder, suicideAlcoholism_cell_0_4_1
DurationAlcoholism_header_cell_0_5_0 Long termAlcoholism_cell_0_5_1
CausesAlcoholism_header_cell_0_6_0 Environmental and genetic factorsAlcoholism_cell_0_6_1
Risk factorsAlcoholism_header_cell_0_7_0 Stress, anxiety, inexpensive, easy accessAlcoholism_cell_0_7_1
Diagnostic methodAlcoholism_header_cell_0_8_0 Questionnaires, blood testsAlcoholism_cell_0_8_1
TreatmentAlcoholism_header_cell_0_9_0 Alcohol detoxification typically with benzodiazepines, counselling, acamprosate, disulfiram, naltrexoneAlcoholism_cell_0_9_1
FrequencyAlcoholism_header_cell_0_10_0 380 million / 5.1% adults (2016)Alcoholism_cell_0_10_1
DeathsAlcoholism_header_cell_0_11_0 3.3 million / 5.9%Alcoholism_cell_0_11_1

Alcoholism is, broadly, any drinking of alcohol that results in significant mental or physical health problems. Alcoholism_sentence_3

Alcoholism is not a recognized diagnostic entity. Alcoholism_sentence_4

Predominant diagostic classifications are alcohol use disorder (DSM-5) or alcohol dependence (ICD-11). Alcoholism_sentence_5

Excessive alcohol use can damage all organ systems, but it particularly affects the brain, heart, liver, pancreas and immune system. Alcoholism_sentence_6

Alcoholism can result in mental illness, delirium tremens, Wernicke–Korsakoff syndrome, irregular heartbeat, an impaired immune response, liver cirrhosis and increased cancer risk. Alcoholism_sentence_7

Drinking during pregnancy can result in fetal alcohol spectrum disorders. Alcoholism_sentence_8

Women are generally more sensitive than men to the harmful effects of alcohol, primarily due to their smaller body weight, lower capacity to metabolize alcohol, and higher proportion of body fat. Alcoholism_sentence_9

In a small number of individuals, prolonged, severe alcohol abuse ultimately leads to frank dementia. Alcoholism_sentence_10

Environmental factors and genetics are two factors affecting risk for alcoholism, with about half the risk attributed to each. Alcoholism_sentence_11

Someone with a parent or sibling with alcoholism is three to four times more likely to become an alcoholic themselves, but only a minority of them do. Alcoholism_sentence_12

Environmental factors include social, cultural and behavioral influences. Alcoholism_sentence_13

High stress levels and anxiety, as well as alcohol's inexpensive cost and easy accessibility, increase the risk. Alcoholism_sentence_14

People may continue to drink partly to prevent or improve symptoms of withdrawal. Alcoholism_sentence_15

After a person stops drinking alcohol, they may experience a low level of withdrawal lasting for months. Alcoholism_sentence_16

Medically, alcoholism is considered both a physical and mental illness. Alcoholism_sentence_17

Questionnaires are usually used to detect possible alcoholism. Alcoholism_sentence_18

Further information is then collected to confirm the diagnosis. Alcoholism_sentence_19

Prevention of alcoholism may be attempted by regulating and limiting the sale of alcohol (particularly to minors), taxing alcohol to increase its cost, and providing education and inexpensive treatment. Alcoholism_sentence_20

Prohibition did not work. Alcoholism_sentence_21

Treatment of alcoholism may take several forms. Alcoholism_sentence_22

Due to medical problems that can occur during withdrawal, alcohol detoxification should be carefully controlled. Alcoholism_sentence_23

One common method involves the use of benzodiazepine medications, such as diazepam. Alcoholism_sentence_24

These can be either given while admitted to a health care institution or occasionally while a person remains in the community with close supervision. Alcoholism_sentence_25

Mental illness or other addictions may complicate treatment. Alcoholism_sentence_26

After detoxification, various forms of individual or group therapy or support groups can help keep a person from returning to drinking. Alcoholism_sentence_27

One commonly used form of support is the group Alcoholics Anonymous. Alcoholism_sentence_28

The medications acamprosate, disulfiram or naltrexone may also be used to help prevent further drinking. Alcoholism_sentence_29

The World Health Organization has estimated that as of 2016, there were 380 million people with alcoholism worldwide (5.1% of the population over 15 years of age). Alcoholism_sentence_30

As of 2015 in the United States, about 17 million (7%) of adults and 0.7 million (2.8%) of those age 12 to 17 years of age are affected. Alcoholism_sentence_31

Alcoholism is most common among males and young adults. Alcoholism_sentence_32

Geographically, it is least common in Africa (1.1% of the population) and has the highest rates in Eastern Europe (11%). Alcoholism_sentence_33

Alcoholism directly resulted in 139,000 deaths in 2013, up from 112,000 deaths in 1990. Alcoholism_sentence_34

A total of 3.3 million deaths (5.9% of all deaths) are believed to be due to alcohol. Alcoholism_sentence_35

Alcoholism reduces a person's life expectancy by approximately ten years. Alcoholism_sentence_36

Many terms, some insulting and others informal, have been used to refer to people affected by alcoholism; the expressions include tippler, drunkard, dipsomaniac and souse. Alcoholism_sentence_37

In 1979, the World Health Organization discouraged the use of "alcoholism" due to its inexact meaning, preferring "alcohol dependence syndrome". Alcoholism_sentence_38

Signs and symptoms Alcoholism_section_0

The risk of alcohol dependence begins at low levels of drinking and increases directly with both the volume of alcohol consumed and a pattern of drinking larger amounts on an occasion, to the point of intoxication, which is sometimes called "binge drinking". Alcoholism_sentence_39

Long-term misuse Alcoholism_section_1

Alcoholism is characterised by an increased tolerance to alcohol – which means that an individual can consume more alcohol – and physical dependence on alcohol, which makes it hard for an individual to control their consumption. Alcoholism_sentence_40

The physical dependency caused by alcohol can lead to an affected individual having a very strong urge to drink alcohol. Alcoholism_sentence_41

These characteristics play a role in decreasing an alcoholic's ability to stop drinking. Alcoholism_sentence_42

Alcoholism can have adverse effects on mental health, contributing to psychiatric disorders and increasing the risk of suicide. Alcoholism_sentence_43

A depressed mood is a common symptom of heavy alcohol drinkers. Alcoholism_sentence_44

Warning signs Alcoholism_section_2

Warning signs of alcoholism include the consumption of increasing amounts of alcohol and frequent intoxication, preoccupation with drinking to the exclusion of other activities, promises to quit drinking and failure to keep those promises, the inability to remember what was said or done while drinking (colloquially known as "blackouts"), personality changes associated with drinking, denial or the making of excuses for drinking, the refusal to admit excessive drinking, dysfunction or other problems at work or school, the loss of interest in personal appearance or hygiene, marital and economic problems, and the complaint of poor health, with loss of appetite, respiratory infections, or increased anxiety. Alcoholism_sentence_45

Physical Alcoholism_section_3

Short-term effects Alcoholism_section_4

Main article: Short-term effects of alcohol consumption Alcoholism_sentence_46

Drinking enough to cause a blood alcohol concentration (BAC) of 0.03–0.12% typically causes an overall improvement in mood and possible euphoria (a "happy" feeling), increased self-confidence and sociability, decreased anxiety, a flushed, red appearance in the face and impaired judgment and fine muscle coordination. Alcoholism_sentence_47

A BAC of 0.09% to 0.25% causes lethargy, sedation, balance problems and blurred vision. Alcoholism_sentence_48

A BAC of 0.18% to 0.30% causes profound confusion, impaired speech (e.g. slurred speech), staggering, dizziness and vomiting. Alcoholism_sentence_49

A BAC from 0.25% to 0.40% causes stupor, unconsciousness, anterograde amnesia, vomiting (death may occur due to inhalation of vomit (pulmonary aspiration) while unconscious) and respiratory depression (potentially life-threatening). Alcoholism_sentence_50

A BAC from 0.35% to 0.80% causes a coma (unconsciousness), life-threatening respiratory depression and possibly fatal alcohol poisoning. Alcoholism_sentence_51

With all alcoholic beverages, drinking while driving, operating an aircraft or heavy machinery increases the risk of an accident; many countries have penalties for drunk driving. Alcoholism_sentence_52

Long-term effects Alcoholism_section_5

See also: Long-term effects of alcohol consumption Alcoholism_sentence_53

Having more than one drink a day for women or two drinks for men increases the risk of heart disease, high blood pressure, atrial fibrillation, and stroke. Alcoholism_sentence_54

Risk is greater with binge drinking, which may also result in violence or accidents. Alcoholism_sentence_55

About 3.3 million deaths (5.9% of all deaths) are believed to be due to alcohol each year. Alcoholism_sentence_56

Alcoholism reduces a person's life expectancy by around ten years and alcohol use is the third leading cause of early death in the United States. Alcoholism_sentence_57

No professional medical association recommends that people who are nondrinkers should start drinking. Alcoholism_sentence_58

Long-term alcohol abuse can cause a number of physical symptoms, including cirrhosis of the liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, nutritional deficiencies, peptic ulcers and sexual dysfunction, and can eventually be fatal. Alcoholism_sentence_59

Other physical effects include an increased risk of developing cardiovascular disease, malabsorption, alcoholic liver disease, and several cancers. Alcoholism_sentence_60

Damage to the central nervous system and peripheral nervous system can occur from sustained alcohol consumption. Alcoholism_sentence_61

A wide range of immunologic defects can result and there may be a generalized skeletal fragility, in addition to a recognized tendency to accidental injury, resulting a propensity to bone fractures. Alcoholism_sentence_62

Women develop long-term complications of alcohol dependence more rapidly than do men. Alcoholism_sentence_63

Additionally, women have a higher mortality rate from alcoholism than men. Alcoholism_sentence_64

Examples of long-term complications include brain, heart, and liver damage and an increased risk of breast cancer. Alcoholism_sentence_65

Additionally, heavy drinking over time has been found to have a negative effect on reproductive functioning in women. Alcoholism_sentence_66

This results in reproductive dysfunction such as anovulation, decreased ovarian mass, problems or irregularity of the menstrual cycle, and early menopause. Alcoholism_sentence_67

Alcoholic ketoacidosis can occur in individuals who chronically abuse alcohol and have a recent history of binge drinking. Alcoholism_sentence_68

The amount of alcohol that can be biologically processed and its effects differ between sexes. Alcoholism_sentence_69

Equal dosages of alcohol consumed by men and women generally result in women having higher blood alcohol concentrations (BACs), since women generally have a lower weight and higher percentage of body fat and therefore a lower volume of distribution for alcohol than men. Alcoholism_sentence_70

Psychiatric Alcoholism_section_6

Long-term misuse of alcohol can cause a wide range of mental health problems. Alcoholism_sentence_71

Severe cognitive problems are common; approximately 10 percent of all dementia cases are related to alcohol consumption, making it the second leading cause of dementia. Alcoholism_sentence_72

Excessive alcohol use causes damage to brain function, and psychological health can be increasingly affected over time. Alcoholism_sentence_73

Social skills are significantly impaired in people suffering from alcoholism due to the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area of the brain. Alcoholism_sentence_74

The social skills that are impaired by alcohol abuse include impairments in perceiving facial emotions, prosody perception problems and theory of mind deficits; the ability to understand humour is also impaired in alcohol abusers. Alcoholism_sentence_75

Psychiatric disorders are common in alcoholics, with as many as 25 percent suffering severe psychiatric disturbances. Alcoholism_sentence_76

The most prevalent psychiatric symptoms are anxiety and depression disorders. Alcoholism_sentence_77

Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued abstinence. Alcoholism_sentence_78

Psychosis, confusion, and organic brain syndrome may be caused by alcohol misuse, which can lead to a misdiagnosis such as schizophrenia. Alcoholism_sentence_79

Panic disorder can develop or worsen as a direct result of long-term alcohol misuse. Alcoholism_sentence_80

The co-occurrence of major depressive disorder and alcoholism is well documented. Alcoholism_sentence_81

Among those with comorbid occurrences, a distinction is commonly made between depressive episodes that remit with alcohol abstinence ("substance-induced"), and depressive episodes that are primary and do not remit with abstinence ("independent" episodes). Alcoholism_sentence_82

Additional use of other drugs may increase the risk of depression. Alcoholism_sentence_83

Psychiatric disorders differ depending on gender. Alcoholism_sentence_84

Women who have alcohol-use disorders often have a co-occurring psychiatric diagnosis such as major depression, anxiety, panic disorder, bulimia, post-traumatic stress disorder (PTSD), or borderline personality disorder. Alcoholism_sentence_85

Men with alcohol-use disorders more often have a co-occurring diagnosis of narcissistic or antisocial personality disorder, bipolar disorder, schizophrenia, impulse disorders or attention deficit/hyperactivity disorder (ADHD). Alcoholism_sentence_86

Women with alcoholism are more likely to experience physical or sexual assault, abuse and domestic violence than women in the general population, which can lead to higher instances of psychiatric disorders and greater dependence on alcohol. Alcoholism_sentence_87

Social effects Alcoholism_section_7

See also: Drug-related crime Alcoholism_sentence_88

Serious social problems arise from alcoholism; these dilemmas are caused by the pathological changes in the brain and the intoxicating effects of alcohol. Alcoholism_sentence_89

Alcohol abuse is associated with an increased risk of committing criminal offences, including child abuse, domestic violence, rape, burglary and assault. Alcoholism_sentence_90

Alcoholism is associated with loss of employment, which can lead to financial problems. Alcoholism_sentence_91

Drinking at inappropriate times and behavior caused by reduced judgment can lead to legal consequences, such as criminal charges for drunk driving or public disorder, or civil penalties for tortious behavior. Alcoholism_sentence_92

An alcoholic's behavior and mental impairment while drunk can profoundly affect those surrounding him and lead to isolation from family and friends. Alcoholism_sentence_93

This isolation can lead to marital conflict and divorce, or contribute to domestic violence. Alcoholism_sentence_94

Alcoholism can also lead to child neglect, with subsequent lasting damage to the emotional development of the alcoholic's children. Alcoholism_sentence_95

For this reason, children of alcoholic parents can develop a number of emotional problems. Alcoholism_sentence_96

For example, they can become afraid of their parents, because of their unstable mood behaviors. Alcoholism_sentence_97

In addition, they can develop considerable amount of shame over their inadequacy to liberate their parents from alcoholism. Alcoholism_sentence_98

As a result of this failure, they develop wretched self-images, which can lead to depression. Alcoholism_sentence_99

Alcohol withdrawal Alcoholism_section_8

Main article: Alcohol withdrawal syndrome Alcoholism_sentence_100

See also: Kindling (sedative-hypnotic withdrawal) Alcoholism_sentence_101

As with similar substances with a sedative-hypnotic mechanism, such as barbiturates and benzodiazepines, withdrawal from alcohol dependence can be fatal if it is not properly managed. Alcoholism_sentence_102

Alcohol's primary effect is the increase in stimulation of the GABAA receptor, promoting central nervous system depression. Alcoholism_sentence_103

With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in tolerance and physical dependence. Alcoholism_sentence_104

When alcohol consumption is stopped too abruptly, the person's nervous system suffers from uncontrolled synapse firing. Alcoholism_sentence_105

This can result in symptoms that include anxiety, life-threatening seizures, delirium tremens, hallucinations, shakes and possible heart failure. Alcoholism_sentence_106

Other neurotransmitter systems are also involved, especially dopamine, NMDA and glutamate. Alcoholism_sentence_107

Severe acute withdrawal symptoms such as delirium tremens and seizures rarely occur after 1-week post cessation of alcohol. Alcoholism_sentence_108

The acute withdrawal phase can be defined as lasting between one and three weeks. Alcoholism_sentence_109

In the period of 3–6 weeks following cessation, anxiety, depression, fatigue, and sleep disturbance are common. Alcoholism_sentence_110

Similar post-acute withdrawal symptoms have also been observed in animal models of alcohol dependence and withdrawal. Alcoholism_sentence_111

A kindling effect also occurs in alcoholics whereby each subsequent withdrawal syndrome is more severe than the previous withdrawal episode; this is due to neuroadaptations which occur as a result of periods of abstinence followed by re-exposure to alcohol. Alcoholism_sentence_112

Individuals who have had multiple withdrawal episodes are more likely to develop seizures and experience more severe anxiety during withdrawal from alcohol than alcohol-dependent individuals without a history of past alcohol withdrawal episodes. Alcoholism_sentence_113

The kindling effect leads to persistent functional changes in brain neural circuits as well as to gene expression. Alcoholism_sentence_114

Kindling also results in the intensification of psychological symptoms of alcohol withdrawal. Alcoholism_sentence_115

There are decision tools and questionnaires that help guide physicians in evaluating alcohol withdrawal. Alcoholism_sentence_116

For example, the CIWA-Ar objectifies alcohol withdrawal symptoms in order to guide therapy decisions which allows for an efficient interview while at the same time retaining clinical usefulness, validity, and reliability, ensuring proper care for withdrawal patients, who can be in danger of death. Alcoholism_sentence_117

Causes Alcoholism_section_9

A complex combination of genetic and environmental factors influences the risk of the development of alcoholism. Alcoholism_sentence_118

Genes that influence the metabolism of alcohol also influence the risk of alcoholism, as can a family history of alcoholism. Alcoholism_sentence_119

There is compelling evidence that alcohol use at an early age may influence the expression of genes which increase the risk of alcohol dependence. Alcoholism_sentence_120

These genetic and epigenetic results are regarded as consistent with large longitudinal population studies finding that the younger the age of drinking onset, the greater the prevalence of lifetime alcohol dependence. Alcoholism_sentence_121

Severe childhood trauma is also associated with a general increase in the risk of drug dependency. Alcoholism_sentence_122

Lack of peer and family support is associated with an increased risk of alcoholism developing. Alcoholism_sentence_123

Genetics and adolescence are associated with an increased sensitivity to the neurotoxic effects of chronic alcohol abuse. Alcoholism_sentence_124

Cortical degeneration due to the neurotoxic effects increases impulsive behaviour, which may contribute to the development, persistence and severity of alcohol use disorders. Alcoholism_sentence_125

There is evidence that with abstinence, there is a reversal of at least some of the alcohol induced central nervous system damage. Alcoholism_sentence_126

The use of cannabis was associated with later problems with alcohol use. Alcoholism_sentence_127

Alcohol use was associated with an increased probability of later use of tobacco and illegal drugs such as cannabis. Alcoholism_sentence_128

Availability Alcoholism_section_10

Alcohol is the most available, widely consumed, and widely abused recreational drug. Alcoholism_sentence_129

Beer alone is the world's most widely consumed alcoholic beverage; it is the third-most popular drink overall, after water and tea. Alcoholism_sentence_130

It is thought by some to be the oldest fermented beverage. Alcoholism_sentence_131

Gender difference Alcoholism_section_11

Based on combined data in the US from SAMHSA's 2004–2005 National Surveys on Drug Use & Health, the rate of past-year alcohol dependence or abuse among persons aged 12 or older varied by level of alcohol use: 44.7% of past month heavy drinkers, 18.5% binge drinkers, 3.8% past month non-binge drinkers, and 1.3% of those who did not drink alcohol in the past month met the criteria for alcohol dependence or abuse in the past year. Alcoholism_sentence_132

Males had higher rates than females for all measures of drinking in the past month: any alcohol use (57.5% vs. 45%), binge drinking (30.8% vs. 15.1%), and heavy alcohol use (10.5% vs. 3.3%), and males were twice as likely as females to have met the criteria for alcohol dependence or abuse in the past year (10.5% vs. 5.1%). Alcoholism_sentence_133

Genetic variation Alcoholism_section_12

See also: Addiction § Genetic factors Alcoholism_sentence_134

There are genetic variations that affect the risk for alcoholism. Alcoholism_sentence_135

Some of these variations are more common in individuals with ancestry from certain areas, for example Africa, East Asia, the Middle East and Europe. Alcoholism_sentence_136

The variants with strongest effect are in genes that encode the main enzymes of alcohol metabolism, ADH1B and ALDH2. Alcoholism_sentence_137

These genetic factors influence the rate at which alcohol and its initial metabolic product, acetaldehyde, are metabolized. Alcoholism_sentence_138

They are found at different frequencies in people from different parts of the world. Alcoholism_sentence_139

The alcohol dehydrogenase allele ADH1B*2 causes a more rapid metabolism of alcohol to acetaldehyde, and reduces risk for alcoholism; it is most common in individuals from East Asia and the Middle East. Alcoholism_sentence_140

The alcohol dehydrogenase allele ADH1B*3 also causes a more rapid metabolism of alcohol. Alcoholism_sentence_141

The allele ADH1B*3 is only found in some individuals of African descent and certain Native American tribes. Alcoholism_sentence_142

African Americans and Native Americans with this allele have a reduced risk of developing alcoholism. Alcoholism_sentence_143

Native Americans, however, have a significantly higher rate of alcoholism than average; risk factors such as cultural environmental effects e.g. trauma have been proposed to explain the higher rates. Alcoholism_sentence_144

The aldehyde dehydrogenase allele ALDH2*2 greatly reduces the rate at which acetaldehyde, the initial product of alcohol metabolism, is removed by conversion to acetate; it greatly reduces the risk for alcoholism. Alcoholism_sentence_145

A genome-wide association study of more than 100,000 human individuals identified variants of the gene KLB, which encodes the transmembrane protein β-Klotho, as highly associated with alcohol consumption. Alcoholism_sentence_146

The protein β-Klotho is an essential element in cell surface receptors for hormones involved in modulation of appetites for simple sugars and alcohol. Alcoholism_sentence_147

A GWAS has found differences in the genetics of alcohol consumption and alcohol dependence, although the two are to some degree related. Alcoholism_sentence_148

Diagnosis Alcoholism_section_13

Definition Alcoholism_section_14

Misuse, problem use, abuse, and heavy use of alcohol refer to improper use of alcohol, which may cause physical, social, or moral harm to the drinker. Alcoholism_sentence_149

The Dietary Guidelines for Americans defines "moderate use" as no more than two alcoholic beverages a day for men and no more than one alcoholic beverage a day for women. Alcoholism_sentence_150

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as the amount of alcohol leading to a blood alcohol content (BAC) of 0.08, which, for most adults, would be reached by consuming five drinks for men or four for women over a two-hour period. Alcoholism_sentence_151

According to the NIAAA, men may be at risk for alcohol-related problems if their alcohol consumption exceeds 14 standard drinks per week or 4 drinks per day, and women may be at risk if they have more than 7 standard drinks per week or 3 drinks per day. Alcoholism_sentence_152

It defines a standard drink as one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits. Alcoholism_sentence_153

Despite this risk, a 2014 report in the National Survey on Drug Use and Health found that only 10% of either "heavy drinkers" or "binge drinkers" defined according to the above criteria also met the criteria for alcohol dependence, while only 1.3% of non-binge drinkers met the criteria. Alcoholism_sentence_154

An inference drawn from this study is that evidence-based policy strategies and clinical preventive services may effectively reduce binge drinking without requiring addiction treatment in most cases. Alcoholism_sentence_155

Alcoholism Alcoholism_section_15

The term alcoholism is commonly used amongst laypeople, but the word is poorly defined. Alcoholism_sentence_156

Despite the imprecision inherent in the term, there have been attempts to define how the word alcoholism should be interpreted when encountered. Alcoholism_sentence_157

In 1992, it was defined by the National Council on Alcoholism and Drug Dependence (NCADD) and ASAM as "a primary, chronic disease characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking." Alcoholism_sentence_158

MeSH has had an entry for "alcoholism" since 1999, and references the 1992 definition. Alcoholism_sentence_159

The WHO calls alcoholism "a term of long-standing use and variable meaning", and use of the term was disfavored by a 1979 WHO expert committee. Alcoholism_sentence_160

In professional and research contexts, the term "alcoholism" is not currently favored, but rather alcohol abuse, alcohol dependence, or alcohol use disorder are used. Alcoholism_sentence_161

Talbot (1989) observes that alcoholism in the classical disease model follows a progressive course: if a person continues to drink, their condition will worsen. Alcoholism_sentence_162

This will lead to harmful consequences in their life, physically, mentally, emotionally and socially. Alcoholism_sentence_163

Johnson (1980) explores the emotional progression of the addict's response to alcohol. Alcoholism_sentence_164

He looks at this in four phases. Alcoholism_sentence_165

The first two are considered "normal" drinking and the last two are viewed as "typical" alcoholic drinking. Alcoholism_sentence_166

Johnson's four phases consist of: Alcoholism_sentence_167


  1. Learning the mood swing. A person is introduced to alcohol (in some cultures this can happen at a relatively young age), and the person enjoys the happy feeling it produces. At this stage, there is no emotional cost.Alcoholism_item_0_0
  2. Seeking the mood swing. A person will drink to regain that feeling of euphoria experienced in phase 1; the drinking will increase as more intoxication is required to achieve the same effect. Again at this stage, there are no significant consequences.Alcoholism_item_0_1
  3. At the third stage there are physical and social consequences, i.e., hangovers, family problems, work problems, etc. A person will continue to drink excessively, disregarding the problems.Alcoholism_item_0_2
  4. The fourth stage can be detrimental, as Johnson cites it as a risk for premature death. As a person now drinks to feel normal, they block out the feelings of overwhelming guilt, remorse, anxiety, and shame they experience when sober.Alcoholism_item_0_3


DSM and ICD Alcoholism_section_16

In the United States, the Diagnostic and Statistical Manual of Mental Disorders (DSM) is the most common diagnostic guide for substance use disorders, whereas most countries use the International Classification of Diseases (ICD) for diagnostic (and other) purposes. Alcoholism_sentence_168

The two manuals use similar but not identical nomenclature to classify alcohol problems. Alcoholism_sentence_169


ManualAlcoholism_header_cell_1_0_0 NomenclatureAlcoholism_header_cell_1_0_1 DefinitionAlcoholism_header_cell_1_0_2
DSM-IVAlcoholism_cell_1_1_0 Alcohol abuse, or Alcohol dependenceAlcoholism_cell_1_1_1 Alcoholism_cell_1_1_2
DSM-5Alcoholism_cell_1_2_0 Alcohol use disorderAlcoholism_cell_1_2_1 "A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by [two or more symptoms out of a total of 12], occurring within a 12-month period ...."Alcoholism_cell_1_2_2
ICD-10Alcoholism_cell_1_3_0 Alcohol harmful use, or Alcohol dependence syndromeAlcoholism_cell_1_3_1 Definitions are similar to that of the DSM-IV. The World Health Organization uses the term "alcohol dependence syndrome" rather than alcoholism. The concept of "harmful use" (as opposed to "abuse") was introduced in 1992's ICD-10 to minimize underreporting of damage in the absence of dependence. The term "alcoholism" was removed from ICD between ICD-8/ICDA-8 and ICD-9.Alcoholism_cell_1_3_2
ICD-11Alcoholism_cell_1_4_0 Episode of harmful use of alcohol, Harmful pattern of use of alcohol, or Alcohol dependenceAlcoholism_cell_1_4_1 Alcoholism_cell_1_4_2

Social barriers Alcoholism_section_17

Attitudes and social stereotypes can create barriers to the detection and treatment of alcohol abuse. Alcoholism_sentence_170

This is more of a barrier for women than men. Alcoholism_sentence_171

Fear of stigmatization may lead women to deny that they are suffering from a medical condition, to hide their drinking, and to drink alone. Alcoholism_sentence_172

This pattern, in turn, leads family, physicians, and others to be less likely to suspect that a woman they know is an alcoholic. Alcoholism_sentence_173

In contrast, reduced fear of stigma may lead men to admit that they are suffering from a medical condition, to display their drinking publicly, and to drink in groups. Alcoholism_sentence_174

This pattern, in turn, leads family, physicians, and others to be more likely to suspect that a man they know is an alcoholic. Alcoholism_sentence_175

Screening Alcoholism_section_18

Screening is recommended among those over the age of 18. Alcoholism_sentence_176

Several tools may be used to detect a loss of control of alcohol use. Alcoholism_sentence_177

These tools are mostly self-reports in questionnaire form. Alcoholism_sentence_178

Another common theme is a score or tally that sums up the general severity of alcohol use. Alcoholism_sentence_179

The CAGE questionnaire, named for its four questions, is one such example that may be used to screen patients quickly in a doctor's office. Alcoholism_sentence_180


  • The CAGE questionnaire has demonstrated a high effectiveness in detecting alcohol-related problems; however, it has limitations in people with less severe alcohol-related problems, white women and college students.Alcoholism_item_2_4

Other tests are sometimes used for the detection of alcohol dependence, such as the Alcohol Dependence Data Questionnaire, which is a more sensitive diagnostic test than the CAGE questionnaire. Alcoholism_sentence_181

It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol use. Alcoholism_sentence_182

The Michigan Alcohol Screening Test (MAST) is a screening tool for alcoholism widely used by courts to determine the appropriate sentencing for people convicted of alcohol-related offenses, driving under the influence being the most common. Alcoholism_sentence_183

The Alcohol Use Disorders Identification Test (AUDIT), a screening questionnaire developed by the World Health Organization, is unique in that it has been validated in six countries and is used internationally. Alcoholism_sentence_184

Like the CAGE questionnaire, it uses a simple set of questions – a high score earning a deeper investigation. Alcoholism_sentence_185

The Paddington Alcohol Test (PAT) was designed to screen for alcohol-related problems amongst those attending Accident and Emergency departments. Alcoholism_sentence_186

It concords well with the AUDIT questionnaire but is administered in a fifth of the time. Alcoholism_sentence_187

Urine and blood tests Alcoholism_section_19

There are reliable tests for the actual use of alcohol, one common test being that of blood alcohol content (BAC). Alcoholism_sentence_188

These tests do not differentiate alcoholics from non-alcoholics; however, long-term heavy drinking does have a few recognizable effects on the body, including: Alcoholism_sentence_189


With regard to alcoholism, BAC is useful to judge alcohol tolerance, which in turn is a sign of alcoholism. Alcoholism_sentence_190

Electrolyte and acid-base abnormalities including hypokalemia, hypomagnesemia, hyponatremia, hyperuricemia, metabolic acidosis, and respiratory alkalosis are common in alcoholics. Alcoholism_sentence_191

However, none of these blood tests for biological markers is as sensitive as screening questionnaires. Alcoholism_sentence_192

Prevention Alcoholism_section_20

Further information: Alcohol education Alcoholism_sentence_193

The World Health Organization, the European Union and other regional bodies, national governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism. Alcoholism_sentence_194

Increasing the age at which licit drugs of abuse such as alcohol can be purchased, and banning or restricting alcohol beverage advertising are common methods to reduce alcohol use among adolescents and young adults in particular. Alcoholism_sentence_195

Credible, evidence-based educational campaigns in the mass media about the consequences of alcohol abuse have been recommended. Alcoholism_sentence_196

Guidelines for parents to prevent alcohol abuse amongst adolescents, and for helping young people with mental health problems have also been suggested. Alcoholism_sentence_197

Management Alcoholism_section_21

Treatments are varied because there are multiple perspectives of alcoholism. Alcoholism_sentence_198

Those who approach alcoholism as a medical condition or disease recommend differing treatments from, for instance, those who approach the condition as one of social choice. Alcoholism_sentence_199

Most treatments focus on helping people discontinue their alcohol intake, followed up with life training and/or social support to help them resist a return to alcohol use. Alcoholism_sentence_200

Since alcoholism involves multiple factors which encourage a person to continue drinking, they must all be addressed to successfully prevent a relapse. Alcoholism_sentence_201

An example of this kind of treatment is detoxification followed by a combination of supportive therapy, attendance at self-help groups, and ongoing development of coping mechanisms. Alcoholism_sentence_202

Much of the treatment community for alcoholism supports an abstinence-based zero tolerance approach; however, some prefer a harm-reduction approach. Alcoholism_sentence_203

Detoxification Alcoholism_section_22

Main article: Alcohol detoxification Alcoholism_sentence_204

Alcohol detoxification or 'detox' for alcoholics is an abrupt stop of alcohol drinking coupled with the substitution of drugs, such as benzodiazepines, that have similar effects to prevent alcohol withdrawal. Alcoholism_sentence_205

Individuals who are only at risk of mild to moderate withdrawal symptoms can be detoxified as outpatients. Alcoholism_sentence_206

Individuals at risk of a severe withdrawal syndrome as well as those who have significant or acute comorbid conditions are generally treated as inpatients. Alcoholism_sentence_207

Detoxification does not actually treat alcoholism, and it is necessary to follow up detoxification with an appropriate treatment program for alcohol dependence or abuse to reduce the risk of relapse. Alcoholism_sentence_208

Some symptoms of alcohol withdrawal such as depressed mood and anxiety typically take weeks or months to abate while other symptoms persist longer due to persisting neuroadaptations. Alcoholism_sentence_209

Alcoholism has serious adverse effects on brain function; on average it takes one year of abstinence to recover from the cognitive deficits incurred by chronic alcohol abuse. Alcoholism_sentence_210

Psychological Alcoholism_section_23

Various forms of group therapy or psychotherapy can be used to deal with underlying psychological issues that are related to alcohol addiction, as well as provide relapse prevention skills. Alcoholism_sentence_211

The mutual-help group-counseling approach is one of the most common ways of helping alcoholics maintain sobriety. Alcoholism_sentence_212

Alcoholics Anonymous was one of the first organizations formed to provide mutual, nonprofessional counseling, and it is still the largest. Alcoholism_sentence_213

Others include LifeRing Secular Recovery, SMART Recovery, Women for Sobriety, and Secular Organizations for Sobriety. Alcoholism_sentence_214

Alcoholics Anonymous and twelve-step programs appear more effective than cognitive behavioral therapy or abstinence. Alcoholism_sentence_215

Moderate drinking Alcoholism_section_24

Rationing and moderation programs such as Moderation Management and DrinkWise do not mandate complete abstinence. Alcoholism_sentence_216

While most alcoholics are unable to limit their drinking in this way, some return to moderate drinking. Alcoholism_sentence_217

A 2002 US study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed that 17.7 percent of individuals diagnosed as alcohol dependent more than one year prior returned to low-risk drinking. Alcoholism_sentence_218

This group, however, showed fewer initial symptoms of dependency. Alcoholism_sentence_219

A follow-up study, using the same subjects that were judged to be in remission in 2001–2002, examined the rates of return to problem drinking in 2004–2005. Alcoholism_sentence_220

The study found abstinence from alcohol was the most stable form of remission for recovering alcoholics. Alcoholism_sentence_221

There was also a 1973 study showing chronic alcoholics drinking moderately again, but a 1982 follow-up showed that 95% of subjects were not able to moderately drink over the long term. Alcoholism_sentence_222

Another study was a long-term (60 year) follow-up of two groups of alcoholic men which concluded that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence." Alcoholism_sentence_223

Internet based measures appear to be useful at least in the short term. Alcoholism_sentence_224

Medications Alcoholism_section_25

In the United States there are four approved medications for alcoholism: acamprosate, two methods of using naltrexone and disulfiram. Alcoholism_sentence_225


  • Acamprosate may stabilise the brain chemistry that is altered due to alcohol dependence via antagonising the actions of glutamate, a neurotransmitter which is hyperactive in the post-withdrawal phase. By reducing excessive NMDA activity which occurs at the onset of alcohol withdrawal, acamprosate can reduce or prevent alcohol withdrawal related neurotoxicity. Acamprosate reduces the risk of relapse amongst alcohol-dependent persons.Alcoholism_item_4_9
  • Naltrexone is a competitive antagonist for opioid receptors, effectively blocking the effects of endorphins and opioids. Naltrexone is used to decrease cravings for alcohol and encourage abstinence. Alcohol causes the body to release endorphins, which in turn release dopamine and activate the reward pathways; hence in the body reduces the pleasurable effects from consuming alcohol. Evidence supports a reduced risk of relapse among alcohol-dependent persons and a decrease in excessive drinking. Nalmefene also appears effective and works in a similar manner.Alcoholism_item_4_10
  • The Sinclair method is another approach to using naltrexone or other opioid antagonists to treat alcoholism by having the person take the medication about an hour before they drink alcohol and only then. The medication blocks the positive reinforcement effects of ethanol and hypothetically allows the person to stop drinking or drink less.Alcoholism_item_4_11
  • Disulfiram prevents the elimination of acetaldehyde, a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many hangover symptoms from alcohol use. The overall effect is discomfort when alcohol is ingested: an extremely fast-acting and long-lasting, uncomfortable hangover.Alcoholism_item_4_12

Several other drugs are also used and many are under investigation. Alcoholism_sentence_226


  • Benzodiazepines, while useful in the management of acute alcohol withdrawal, if used long-term can cause a worse outcome in alcoholism. Alcoholics on chronic benzodiazepines have a lower rate of achieving abstinence from alcohol than those not taking benzodiazepines. This class of drugs is commonly prescribed to alcoholics for insomnia or anxiety management. Initiating prescriptions of benzodiazepines or sedative-hypnotics in individuals in recovery has a high rate of relapse with one author reporting more than a quarter of people relapsed after being prescribed sedative-hypnotics. Those who are long-term users of benzodiazepines should not be withdrawn rapidly, as severe anxiety and panic may develop, which are known risk factors for relapse into alcohol abuse. Taper regimes of 6–12 months have been found to be the most successful, with reduced intensity of withdrawal.Alcoholism_item_5_13
  • Calcium carbimide works in the same way as disulfiram; it has an advantage in that the occasional adverse effects of disulfiram, hepatotoxicity and drowsiness, do not occur with calcium carbimide.Alcoholism_item_5_14
  • Ondansetron and topiramate are supported by tentative evidence in people with certain genetics. Evidence for ondansetron is more in those who have just begun having problems with alcohol.Alcoholism_item_5_15

Evidence does not support the use of selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), antipsychotics, or gabapentin. Alcoholism_sentence_227

Dual addictions and dependences Alcoholism_section_26

Alcoholics may also require treatment for other psychotropic drug addictions and drug dependences. Alcoholism_sentence_228

The most common dual dependence syndrome with alcohol dependence is benzodiazepine dependence, with studies showing 10–20 percent of alcohol-dependent individuals had problems of dependence and/or misuse problems of benzodiazepine drugs such as diazepam or clonazepam. Alcoholism_sentence_229

These drugs are, like alcohol, depressants. Alcoholism_sentence_230

Benzodiazepines may be used legally, if they are prescribed by doctors for anxiety problems or other mood disorders, or they may be purchased as illegal drugs. Alcoholism_sentence_231

Benzodiazepine use increases cravings for alcohol and the volume of alcohol consumed by problem drinkers. Alcoholism_sentence_232

Benzodiazepine dependency requires careful reduction in dosage to avoid benzodiazepine withdrawal syndrome and other health consequences. Alcoholism_sentence_233

Dependence on other sedative-hypnotics such as zolpidem and zopiclone as well as opiates and illegal drugs is common in alcoholics. Alcoholism_sentence_234

Alcohol itself is a sedative-hypnotic and is cross-tolerant with other sedative-hypnotics such as barbiturates, benzodiazepines and nonbenzodiazepines. Alcoholism_sentence_235

Dependence upon and withdrawal from sedative-hypnotics can be medically severe and, as with alcohol withdrawal, there is a risk of psychosis or seizures if not properly managed. Alcoholism_sentence_236

Epidemiology Alcoholism_section_27

The World Health Organization estimates that as of 2016 there are 380 million people with alcoholism worldwide (5.1% of the population over 15 years of age). Alcoholism_sentence_237

Substance use disorders are a major public health problem facing many countries. Alcoholism_sentence_238

"The most common substance of abuse/dependence in patients presenting for treatment is alcohol." Alcoholism_sentence_239

In the United Kingdom, the number of 'dependent drinkers' was calculated as over 2.8 million in 2001. Alcoholism_sentence_240

About 12% of American adults have had an alcohol dependence problem at some time in their life. Alcoholism_sentence_241

In the United States and Western Europe, 10 to 20 percent of men and 5 to 10 percent of women at some point in their lives will meet criteria for alcoholism. Alcoholism_sentence_242

Estonia had the highest death rate from alcohol in Europe in 2015 at 8.8 per 100,000 population. Alcoholism_sentence_243

In the United States, 30% of people admitted to hospital have a problem related to alcohol. Alcoholism_sentence_244

Within the medical and scientific communities, there is a broad consensus regarding alcoholism as a disease state. Alcoholism_sentence_245

For example, the American Medical Association considers alcohol a drug and states that "drug addiction is a chronic, relapsing brain disease characterized by compulsive drug seeking and use despite often devastating consequences. Alcoholism_sentence_246

It results from a complex interplay of biological vulnerability, environmental exposure, and developmental factors (e.g., stage of brain maturity)." Alcoholism_sentence_247

Alcoholism has a higher prevalence among men, though, in recent decades, the proportion of female alcoholics has increased. Alcoholism_sentence_248

Current evidence indicates that in both men and women, alcoholism is 50–60 percent genetically determined, leaving 40–50 percent for environmental influences. Alcoholism_sentence_249

Most alcoholics develop alcoholism during adolescence or young adulthood. Alcoholism_sentence_250

Prognosis Alcoholism_section_28

Alcoholism often reduces a person's life expectancy by around ten years. Alcoholism_sentence_251

The most common cause of death in alcoholics is from cardiovascular complications. Alcoholism_sentence_252

There is a high rate of suicide in chronic alcoholics, which increases the longer a person drinks. Alcoholism_sentence_253

Approximately 3–15 percent of alcoholics commit suicide, and research has found that over 50 percent of all suicides are associated with alcohol or drug dependence. Alcoholism_sentence_254

This is believed to be due to alcohol causing physiological distortion of brain chemistry, as well as social isolation. Alcoholism_sentence_255

Suicide is also very common in adolescent alcohol abusers, with 25 percent of suicides in adolescents being related to alcohol abuse. Alcoholism_sentence_256

Among those with alcohol dependence after one year, some met the criteria for low-risk drinking, even though only 25.5 percent of the group received any treatment, with the breakdown as follows: 25 percent were found to be still dependent, 27.3 percent were in partial remission (some symptoms persist), 11.8 percent asymptomatic drinkers (consumption increases chances of relapse) and 35.9 percent were fully recovered – made up of 17.7 percent low-risk drinkers plus 18.2 percent abstainers. Alcoholism_sentence_257

In contrast, however, the results of a long-term (60-year) follow-up of two groups of alcoholic men indicated that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence." Alcoholism_sentence_258

There was also "return-to-controlled drinking, as reported in short-term studies, is often a mirage." Alcoholism_sentence_259

History Alcoholism_section_29

Historically the name "dipsomania" was coined by German physician C.W. Alcoholism_sentence_260 Hufeland in 1819 before it was superseded by "alcoholism". Alcoholism_sentence_261

That term now has a more specific meaning. Alcoholism_sentence_262

The term "alcoholism" was first used in 1849 by the Swedish physician Magnus Huss to describe the systematic adverse effects of alcohol. Alcoholism_sentence_263

Alcohol has a long history of use and misuse throughout recorded history. Alcoholism_sentence_264

Biblical, Egyptian and Babylonian sources record the history of abuse and dependence on alcohol. Alcoholism_sentence_265

In some ancient cultures alcohol was worshiped and in others, its abuse was condemned. Alcoholism_sentence_266

Excessive alcohol misuse and drunkenness were recognized as causing social problems even thousands of years ago. Alcoholism_sentence_267

However, the defining of habitual drunkenness as it was then known as and its adverse consequences were not well established medically until the 18th century. Alcoholism_sentence_268

In 1647 a Greek monk named Agapios was the first to document that chronic alcohol misuse was associated with toxicity to the nervous system and body which resulted in a range of medical disorders such as seizures, paralysis, and internal bleeding. Alcoholism_sentence_269

In 1920 the effects of alcohol abuse and chronic drunkenness boosted membership of the temperance movement and led to the prohibition of alcohol in the United States, a nationwide constitutional ban on the production, importation, transportation, and sale of alcoholic beverages that remained in place until 1933; this policy resulted in the decline of death rates from cirrhosis and alcoholism. Alcoholism_sentence_270

In 2005 alcohol dependence and abuse was estimated to cost the US economy approximately 220 billion dollars per year, more than cancer and obesity. Alcoholism_sentence_271

Society and culture Alcoholism_section_30

See also: List of deaths through alcohol Alcoholism_sentence_272

The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to society, for example, money due to lost labor-hours, medical costs due to injuries due to drunkenness and organ damage from long-term use, and secondary treatment costs, such as the costs of rehabilitation facilities and detoxification centers. Alcoholism_sentence_273

Alcohol use is a major contributing factor for head injuries, motor vehicle injuriess (27%), interpersonal violence (18%), suicides (18%), and epilepsy (13%). Alcoholism_sentence_274

Beyond the financial costs that alcohol consumption imposes, there are also significant social costs to both the alcoholic and their family and friends. Alcoholism_sentence_275

For instance, alcohol consumption by a pregnant woman can lead to an incurable and damaging condition known as fetal alcohol syndrome, which often results in cognitive deficits, mental health problems, an inability to live independently and an increased risk of criminal behaviour, all of which can cause emotional stress for parents and caregivers. Alcoholism_sentence_276

Estimates of the economic costs of alcohol abuse, collected by the World Health Organization, vary from one to six percent of a country's GDP. Alcoholism_sentence_277

One Australian estimate pegged alcohol's social costs at 24% of all drug abuse costs; a similar Canadian study concluded alcohol's share was 41%. Alcoholism_sentence_278

One study quantified the cost to the UK of all forms of alcohol misuse in 2001 as £18.5–20 billion. Alcoholism_sentence_279

All economic costs in the United States in 2006 have been estimated at $223.5 billion. Alcoholism_sentence_280

The idea of hitting rock bottom refers to an experience of stress that is blamed on alcohol misuse. Alcoholism_sentence_281

There is no single definition for this idea, and people may identify their own lowest points in terms of lost jobs, lost relationships, health problems, legal problems, or other consequences of alcohol misuse. Alcoholism_sentence_282

The concept is promoted by 12-step recovery groups and researchers using the transtheoretical model of motivation for behavior change. Alcoholism_sentence_283

The first use of this slang phrase in the formal medical literature appeared in a 1965 review in the British Medical Journal, which said that some men refused treatment until they "hit rock bottom", but that treatment was generally more successful for "the alcohol addict who has friends and family to support him" than for impoverished and homeless addicts. Alcoholism_sentence_284

Stereotypes of alcoholics are often found in fiction and popular culture. Alcoholism_sentence_285

The "town drunk" is a stock character in Western popular culture. Alcoholism_sentence_286

Stereotypes of drunkenness may be based on racism or xenophobia, as in the fictional depiction of the Irish as heavy drinkers. Alcoholism_sentence_287

Studies by social psychologists Stivers and Greeley attempt to document the perceived prevalence of high alcohol consumption amongst the Irish in America. Alcoholism_sentence_288

Alcohol consumption is relatively similar between many European cultures, the United States, and Australia. Alcoholism_sentence_289

In Asian countries that have a high gross domestic product, there is heightened drinking compared to other Asian countries, but it is nowhere near as high as it is in other countries like the United States. Alcoholism_sentence_290

It is also inversely seen, with countries that have very low gross domestic product showing high alcohol consumption. Alcoholism_sentence_291

In a study done on Korean immigrants in Canada, they reported alcohol was even an integral part of their meal, and is the only time solo drinking should occur. Alcoholism_sentence_292

They also believe alcohol is necessary at any social event as it helps conversations start. Alcoholism_sentence_293

Caucasians have a much lower abstinence rate (11.8%) and much higher tolerance to symptoms (3.4±2.45 drinks) of alcohol than Chinese (33.4% and 2.2±1.78 drinks respectively). Alcoholism_sentence_294

Also, the more acculturation there is between cultures, the more influenced the culture is to adopt Caucasians drinking practices. Alcoholism_sentence_295

Peyote, a psychoactive agent, has even shown promise in treating alcoholism. Alcoholism_sentence_296

Alcohol had actually replaced peyote as Native Americans’ psychoactive agent of choice in rituals when peyote was outlawed. Alcoholism_sentence_297

Research Alcoholism_section_31

Topiramate Alcoholism_section_32

Topiramate is a derivative of the naturally occurring sugar monosaccharide D-fructose. Alcoholism_sentence_298

Review articles characterize topiramate as showing "encouraging", "promising", "efficacious", and "insufficient" evidence in the treatment of alcohol use disorders. Alcoholism_sentence_299

See also Alcoholism_section_33

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