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Alcohol dependence is a chronic pattern of alcohol abuse. An alcoholic gets used to the effects of alcohol and requires more alcohol to get the desired effect. This is called tolerance. A person with alcohol dependence may experience an uncontrollable need for alcohol.

What is going on in the body?

Alcohol is a depressant. At a blood alcohol level of 0.05%, thought, judgment and restraint are affected. At a level of 0.05% to 0.1%, motor skills become clumsy. When the blood alcohol level reaches 0.2%, the entire area of the brain that controls motor function is negatively affected.

Alcohol also affects the parts of the brain that control emotions and behavior. At 0.3%, the person is likely to be confused and stuporous. An individual at a blood alcohol level of 0.4% or higher may go into a coma. If blood alcohol levels exceed 0.5%, an individual might choke on vomit or stop breathing.

It should be noted that the effects described for each blood level represent approximate responses in the average person. A person with heavy alcohol intake over a long time period may have less effect at a given alcohol concentration.

Moreover, prolonged alcohol use can actually alter and damage the brain. People with alcoholism may have impaired memory, poor concentration, and inability to focus after a distraction.

What are the signs and symptoms of the condition?

• alcohol withdrawal when drinking stops suddenly. Withdrawal symptoms include nervousness, shaking, irritability, and nausea.
• increased tolerance to alcohol
• alcohol consumed in larger amounts or over a longer period than was intended
• unsuccessful attempts to stop drinking
• considerable time devoted to activities associated with alcohol use or obtaining alcohol
• neglected daily activities
• disregard for consequences of negative behaviors

What are the causes and risks of the condition?

Research has shown that genetic factors make an individual more susceptible to alcoholism. However, the mechanisms of inheritance are still being worked out. In addition, environmental influences play a part - and obviously, a person will not become an alcoholic if he or she chooses not to drink alcohol.

Factors that increase a person's chance of becoming dependent on alcohol include:

• frequent social situations that encourage drinking
• childhood history of attention deficit hyperactivity disorder or conduct disorder
• personality disorders
• one or both parents dependent upon alcohol
• alcohol abuse by a young adult that begins as weekend or evening drinking

What can be done to prevent the condition?

Teaching people, particularly those who are at risk for the disease, about alcoholism is important. This education needs to be started at a young age.

How is the condition diagnosed?

There is no test to determine if an individual is an alcoholic. But the negative effects of alcohol on the body can be identified with laboratory tests. These laboratory tests will show damage to various organs or body systems.

What are the long-term effects of the condition?

The long-term effects of alcohol dependency include:

• pancreatitis, that is, inflammation of the pancreas
• heart disease, including coronary artery disease
• neuropathy, that is, damage to the nerves
• bleeding esophageal varices, that is, enlarged veins in the tube that connects the windpipe to the stomach
• brain degeneration and alcoholic neuropathy
• cirrhosis of the liver, a chronic disease that causes destruction of liver cells and loss of liver function
• depression, insomnia, anxiety, and suicide
• high blood pressure
• increased incidence of many types of cancer, including breast cancer
• nutritional deficiencies
• Wernicke-Korsakoff syndrome, a neuropsychiatric disorder caused by thiamine deficiency that results from poor nutrition in alcoholics
• significant damage to occupational, social, and interpersonal functioning, including sexual dysfunction
• a higher risk of motor vehicle crashes and other injuries

Children and teenagers who abuse alcohol are at increased risk for further drinking problems, depression, other substance abuse, and personality disorders as they get older. Adolescents who drink alcohol heavily can develop significant impairments in their ability to remember new information, and their schoolwork may suffer.

People who are heavy drinkers also tend to smoke and eat an unhealthy diet. This combination puts the person at higher risk for coronary artery disease, stroke, heart attack, diabetes, and other chronic diseases.

What are the risks to others?

If a woman drinks alcohol during pregnancy, her unborn child is at great risk for developing fetal alcohol syndrome (FAS). Drinking reduces judgment, impulse control, and motor control. A person with alcohol dependency places himself or herself and others at risk for physical and emotional injuries.

What are the treatments for the condition?

Treatment begins with helping the person to recognize the problem. Alcohol dependency is associated with a tendency to deny the severity of the problem. There is generally a refusal to admit it to others.

Once the person has recognized and admitted a problem, treatment begins with sobriety, that is, no alcohol intake. Some individuals who are alcohol dependent will need to be medically detoxified. This is done in a healthcare setting. Potential complications are monitored during the detoxification process. Tranquilizers and sedatives are used for 4 to 7 days to control the symptoms of alcohol withdrawal.

Alcohol recovery programs help people identify situations that trigger the desire to drink. These programs also help people develop coping skills and life management systems, so they can live without alcohol. Self-help groups such as Alcoholics Anonymous have been effective in helping thousands of alcoholics remain sober.

Occasionally, a medication known as disulfiram (i.e, Antabuse) is used, which interferes with the metabolism of alcohol, producing nausea and vomiting when a person drinks. The medication is intended as a deterrent in case the person should be tempted to drink. It does not eliminate the need for motivation to stay sober.

Other medications that may enhance abstinence from alcohol include naltrexone (i.e., ReVia, Vivitrol), acamprosate (i.e., Campral), topiramate (i.e., Topamax), gabapentin (i.e., Neurontin), and vigabatrin (i.e., Sabril).

What are the side effects of the treatments?

Disulfiram may cause drowsiness, depression, and erectile dysfunction. It also has a long list of possible interactions with other medications. For this reason, a person on disulfiram needs close follow-up by the healthcare professional.

What happens after treatment for the condition?

Individuals who complete treatment for alcohol dependence often will continue some form of counseling or 12-step self-help group (i.e., Alcoholics Anonymous). A person in alcohol recovery will often voluntarily continue to attend self-help groups indefinitely.

How is the condition monitored?

Alcohol dependence is monitored by healthcare professionals, counselors, family, and friends. Any new or worsening symptoms should be reported to the healthcare professional.