Alcohol consumption as a Health care Challenge 

What is Alcohol
Dependence

    The
DSM-IV (American Psychiatric Association, 1994) diagnostic term for alcoholism
is alcohol dependence. Although many people still use the older term
“alcoholism.” Alcohol dependence is a chronic relapsing disease
involving craving for, loss of control over, physical dependence on, and higher
than normal tolerance for alcohol. 

Consequences Or Effects

    The excessive intake of alcohol over time
leads to social, emotional, and physical damage to health, interpersonal/
familial relationships, and occupational status. It is a primary disease with
genetic, psychological, lifestyle, and environmental causal influences that
have not been adequately differentiated to date. 

    Alcohol is a depressant drug and continued abuse leads to negative psychological and physical detriments including hypertension, cardiac arrhythmias, cardiomyopathy, hemorrhagic stroke, liver damage, distortions and errors in conceptual thought. processes, memory decrements, depression, increased risk for all types of accidents, and risk for suicide.

 Some Health Benefits 

    Alcohol is a solvent that
permeates all body cells, including the blood-brain barrier, and has
lipid-dissolving qualities. It is this latter quality that leads to findings
that moderate drinking decreases fatty plaques in blood vessels and thus
decreases the risk for heart attacks. 

How Measure Alcoholism 

    Measuring
alcohol intake presents research challenges. The amount of alcohol in. a
standard drink differs across countries and is made more complex by the fact
that beer, wine, and other drinks may contain differing percentages of pure
alcohol. 

    Generally, in the US a standard drink is 12 ounces (oz.) of beer or
wine cooler, 5 oz. of wine, or 1.5 oz. of 80 proof distilled spirits; that is,
approximately 12 grams of pure alcohol per drink. 

    Collecting data about alcohol
intake is complex; in addition to the basic measure of a standard drink, it is
crucial to determine the number of drinks consumed in a week or a month, the
duration of the current and any prior patterns of alcohol intake, the number of
drinks consumed in one drinking episode (hinge drinking is defined as five or
more drinks for a man and four or more for a woman during one episode), and the
number of binge episodes during the past month/year. 

    Although many survey
instruments and biomarkers exist to measure the amounts and effects of alcohol
intake, no single approach. is valid and reliable for men and women; across age
groups; or for differentiating among binge drinking, alcohol abuse, and alcohol
dependence. Blood alcohol level only reveals intake within recent hours, but
does not inform about recurring or chronic intake. 

    Carbohydrate deficient
transferrin informs about longer term heavy drinking, but has acceptable
sensitivity and specificity primarily for young adult and middle-aged men; it
is much less valid for older men and for women of all ages. Most other
biomarkers are not specific to alcohol effects, but simply report abnormalities
in liver enzymes or hematological contents. 

    There is also a measurement issue
related to abstinence in comparison groups; it is essential to separate out
“sick quitters” from lifelong abstainers or very low quantity users. Otherwise,
the results of studies are contaminated by the presence of subjects with
alcohol-related sequelae (i.e. sick quitters) in the abstainer group.

Most Pron Population

    Young
adults, especially men, have the highest rate of drinking, binge drinking, and
heavy drinking. Women at all ages drink less, but are at higher risk for
negative effects of alcohol. The reasons have not been clearly explicated, but
lower body water to lipid content and less muscle mass are generally accepted
facts. 

    More controversial is the hypothesis that women produce much less
alcohol dehydrogenase, thus increasing the time necessary for first pass
metabolism and prolonging the half-life of pure alcohol in body systems. 

    Whatever the cause, women experience higher levels of cardiac, liver, and other
system dysfunctions and psychological distress (depression and suicide
attempts) earlier in their drinking histories and at much lower quantities
compared to men. 

    These findings led to the NIAAA (1995) guideline for moderate
drinking of two standard drinks per day for young and middle adult men and one
standard drink per day for non-pregnant women of all ages and elderly men.

Alcoholism and Health Issues 

    Fetal
alcohol syndrome (FAS) and alcohol-related birth defects (ARBD) are
manifestations of neurodevelopmental insults that result from alcohol ingestion
by the mother during pregnancy. The negative effects are especially marked
during periods of fetal brain growth spurts and continue during the. postnatal
period for breast-fed infants of drinking mothers. 

    Consequences of FAS, and the
milder form ARBD, include impaired attention, intelligence, memory, motor
coordination, complex problem solving, and abstract thinking. There are also physical
stigmata that attend FAS including abnormal facial features and other
anatomical alterations (Connor & Streissguth, 1996).

Alcoholism and Ethnicity

    Alcohol
consumption differs among the three main ethnic groups in the US (Caetano,
Clark, & Tan, 1998). In general, frequent heavy drinking and binge drinking
has decreased among White men (from 20% in 1984 to 12% in 1995), but has
remained stable among Black and Hispanic men (15% and 18% respectively in both
years). 

    Frequent heavy drinking is much less prevalent among all groups of
women (2-5%). Within-group differences exist for ethnic minorities depending on
where they were born. Asians, Pacific Islanders, and Hispanics who were born in
the US have higher rates of heavy drinking than those who immigrated to the US
Unfortunately, Blacks and Hispanics.

How to Deal With Alcoholic Addicted 

    Who
have alcohol problems are much less likely to seek treatment compared to
Whites. Alcohol dependence is treatable with medication regimens (especially
for detoxification), individual and family counseling, support groups, and
self-help groups-primarily Alcoholics Anonymous and the 12 Step Program. 

    Relapses are common, but the key is to get the drinker back into treatment and
after-care following each relapse and eventually sobriety can be attained and
maintained. Family solidarity is required to stop all cover-ups on behalf of
the drinker. It is important that the drinker experience the full consequences
of the drinking without being rescued so that continued denial of the effects
of the drinking becomes impossible.

    The
research opportunities in this field are myriad. At the fundamental science
level research is needed on the root causes of alcohol dependence including the
role of genetics. The reasons for the excess risk among women merit
considerably more research attention.

     Social, behavioral, and cultural studies
are in order to address the many unanswered questions about adolescent
drinking, college hinge drinking, late onset alcohol dependence among elders,
and differential risk for alcohol problems among ethnic minorities. 

    Theory
based interventions should be developed and tested to enhance the case finding,
referral, and successful treatment for adolescents, women, minorities, elderly
persons, and white men. In the area of measurement, the current paper and
pencil survey instruments are biased toward white men and toward the young and
middle aged. 

    New biomarkers must be developed that are sensitive and specific
for women and for older adults. These are but a few of the many areas available
for future inquiry.