An alcohol use disorder involves a pattern of alcohol consumption, which typically includes craving and manifestations of tolerance and / or withdrawal, along with negative psychosocial consequences. Alcoholism and alcohol abuse are common, but less strictly defined terms are used for people with problems related to alcohol.
(See also alcohol toxicity and resignation.) An alcohol use disorder involves a pattern of alcohol consumption, which typically includes craving and manifestations of tolerance and / or withdrawal, along with negative psychosocial consequences. Alcoholism and alcohol abuse are common, but less strictly defined terms are used for people with problems related to alcohol. Alcohol use disorder is quite common. It is estimated that it is in the United States in any 12-month period at 8.5% of adults. Among people aged 18 to 29, an estimated 12-month prevalence is 16.2%. The limit for alcoholism is defined solely by the amount and frequency of drinking:> 14 drinks per week or four drinks per occasion for men> 7 drinks per week or three drinks per occasion for women compared with smaller amounts, these amounts with an increased risk a variety of medical and psycho-social complications associated. The specific etiology of drinking behavior that leads to alcohol abuse, usually begins with a desire to reach a state of elation. Some drinkers who experience this feeling as rewarding, trying to reach common this condition. Some personality traits are common in people who abuse alcohol or are persistently dependent on alcohol: withdrawal, loneliness, shyness, depression, addiction, hostile and self-destructive impulsiveness and sexual immaturity. Alcohol addicts can come from broken homes and possibly have a disturbed relationship with their parents. Drinking patterns and the resulting behavior are influenced by social attitudes that are mediated through culture and education of children. However, these generalizations should not hide the fact that alcoholism may occur in every person, regardless of age, gender, environment, origin, ethnicity or social situation. Therefore, physicians should be alert in all patients for alcohol problems. Genetic factors It is believed that 40 to 60% of the risk variance is based on genetic factors. The incidence of alcohol addiction is with biological children of addicts greater than in adopted children, and the percentage of children alcohol dependent, the problem drinkers, is higher than in the general population. There is evidence for a biochemical predisposition, also data that indicate that some individuals who are dependent on alcohol are less easily intoxicated, d. h., they have a higher threshold for effects on the CNS. Symptoms and complaints Serious social consequences are the rule. Frequent intoxication is obvious and destructive; it affects the social behavior and the ability to work. Injuries are common. Failed relationships and the loss of a job can be among the consequences. People can be arrested for alcohol-related behavior, or for driving under the influence of alcohol, they can lose their license if they are repeatedly noticed. In most states the maximum permissible blood alcohol concentration (BAC) for drivers is 80 mg / d (0.08%). This value is likely to be further reduced in the future. Diagnosis Clinical Investigation care The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) assumes that alcohol use disorder exists when patients have clinically significant impairment or distress, which is characterized by the presence of ? 2 of the following on a period of 12 months manifest: alcohol consumption in larger amounts or for a longer period than intended Persistent desire or unsuccessful attempt to reduce alcohol consumption a lot of time is spent on obtaining and drinking alcohol, as well as for recovering after Craving alcohol Repeated failure to comply obligations at work, home or school due to alcohol the continued alcohol consumption, although because of recurrent are social or interpersonal problems exist. Abandonment of important social, occupational or recreational activities because of alcohol Alcohol use in physically hazardous situations Continued alcohol consumption, despite a physical (eg., Liver disease) or mental disorder (eg., Depression), which is caused by alcohol or worse. Tolerance to alcohol alcohol withdrawal symptoms or alcohol withdrawal due care Some alcohol-related problems will be diagnosed when people come to treatment because of their drinking behavior or a co hängenen disease (z. B. delirium, cirrhosis). However, many of these people their alcohol remain undiagnosed for a long time. Female alcoholics tend more likely to drink alone; thus they usually less frequently experience social stigma. Therefore, many government and professional associations alcohol screenings recommended as part of routine checkups. A phased approach (see Fig. Screening stages in alcohol problems) can help to identify patients who need to be examined more closely. Several validated detailed questionnaires are available, including the AUDIT (identification test for alcohol-related disorders) and the CAGE questionnaire. Clinical Calculator: AUDIT questionnaire for screening alcohol use screening levels for alcohol problems screening level criteria for the application screening method 1 If only one question is possible you have taken> 5 * Drinks with alcohol at a drinking occasions in the last three months? 2 For all patients who say they drink alcohol if time permits, or for patients who answer “yes” to a level-one screening question on how many days a week do you drink alcohol, on average? How many drinks take on a typical day when you drink to be? What is the maximum number of drinks you have taken on a particular day in the last month to be? 3 If Grade 2 screening identifies a risk of alcohol-related problems (ie for men> 14 drinks per week or four drinks per day; for women> 7 drinks per week or three drinks per day), or if the doctor suspects that the patient their alcohol minimize AUDIT = The 10-question alcohol Use Disorders Identification test * A drink is defined as a 12 oz (about 360 ml) beer, 5 oz (about 150 ml) of wine or 1.5 oz (approximately 50 ml) Spirits , Adapted from Fleming MF: Screening and letter intervention in primary care settings. Available from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) website. Therapy rehabilitation programs Outpatient counseling support groups consider medication (eg. As naltrexone, disulfiram, acamprosate) All patients should be advised to reduce their alcohol use among the alcoholism threshold. In patients who were identified as light alcoholics, treatment can begin with a brief discussion of the medical and social consequences and a recommendation to reduce alcohol consumption or to quit, followed by follow-up visits to monitor compliance (s. Brief interventions for alcohol problems). Brief interventions for alcohol problems intervention level criteria for the application of brief intervention method 1 When screening results show that an intervention is necessary, but time is simply the concern articulate about the fact that the patient exceeds the recommended limits and could lead to alcohol-related problems; recommend that the patient stop drinking or reduce 2 If the referral to a specialist does not seem necessary; If abstinence is not necessarily the goal Treat suggest (Trial for Early Alcohol Treatment) protocol: 2 short personal meetings which are 1 month apart, with a continuation telephone call two weeks after each meeting 3 When the patient has symptoms of alcohol abuse or dependence shows; when abstinence is the primary goal motivation support; Transfer to a specialist in patients with serious problems, especially after less intensive measures were unsuccessful, a rehabilitation program is often the best approach. Rehabilitation programs combine psychotherapy, including individual interviews and group therapy under medical supervision. For most patients, an outpatient rehabilitation is sufficient. How long patients remain in the programs is different, usually weeks to months, but possibly even longer if required. Inpatient rehabilitation stays patients with severe alcohol dependence and those with significant comorbidities and medical, reserved psychoactive and addiction problems. The duration of treatment is usually shorter (days to weeks) than the outpatient programs and can be partially determined by the health of the patient. In psychotherapy, the motivation is strengthened and patients learn how to avoid certain circumstances which normally trigger their drinking. For abstinence is social support, even from family and friends is important. Maintenance therapy A permanent abstinence is difficult to maintain. The patient should be warned that he within a few weeks after he has recovered from his last drinking excess, will find most likely an excuse to get back to drink alcohol. He should also be informed that although he can drink maybe a few days or even control a few weeks in rare cases, but it comes sooner or later, most likely back to a loss of control. In addition to counseling in outpatient and inpatient treatment support groups and certain medications can help prevent relapses. Alcoholics Anonymous (AA) is the most popular self-help group. The patient should seek an AA group in which he feels comfortable. Here, the patient is not drinking friends who are always available, and an environment in which he can socialize without that he would have to drink alcohol. The patient also hear from other members of the group as virtually admit any lie or rationalize that he himself has cited as an excuse for his own drinking. The help they give to other alcohol dependence, give him back his self-respect and his confidence that he has previously only found in the alcohol. Many alcoholics hesitate to join the AA, and find an individual or group counseling or family therapy more acceptable. Life Ring Secular Recovery SOS Secular Organizations for Sobriety u. a. are alternative self-help organizations for addicts who refuse a spiritual concept like that of AA and prefer a more secular program. In Germany, numerous other self-help organizations in the field of addiction aid work in addition to the AA. Drug therapy should be used for discussion and not as a sole treatment in addition. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) provides guidelines on along with a number of other publications and resources for doctors and patients to doctors about medical treatment and pharmacotherapy in alcohol dependence. Disulfiram, the first drug for the prevention of relapse in alcoholism, interacts with the metabolism of acetaldehyde (an intermediate product of the oxidation of alcohol), so that acetaldehyde accumulates. The consumption of alcohol within 12 hours of taking disulfiram results after 5-15 minutes facial flushing, then pronounced vasodilation in the face and neck with bloodshot conjunctiva, throbbing headache, tachycardia, hyperventilation and sweating. At high doses of alcohol can follow within 30-60 minutes nausea and vomiting, which can lead to hypotension, dizziness, sometimes fainting and circulatory collapse. This reaction can last up to 3 hours. Since the side effects are so unpleasant, few patients risk the consumption of alcohol during disulfiram therapy. In addition, medicines containing alcohol should be avoided (such as tinctures, elixirs, some over the counter cold and cough medicines that may contain up to 40% alcohol). Disulfiram is contraindicated during pregnancy and in patients with CHF. Treatment can be performed on an outpatient basis after 4-5 days of abstinence. The starting dose is 0.5 g p.o. once daily for 1-3 weeks followed by a maintenance dose of 0.25 g once a day. The effect lasts for 3-7 days after the last dose. The doctor should regularly summoning the patient, so that it continues to play disulfiram within the abstinence program. The overall usefulness of disulfiram has not been confirmed, and the non-compliance is high. Better compliance usually requires adequate social support as the observation of ingestion. For these reasons, the use of disulfiram is now limited. Disulfiram is most effective when it is given under strict supervision highly motivated patients. Naltrexone, an opioid antagonist, reduces in most patients when permanently taking the recidivism rate and the number in which alcohol is consumed of days. As a rule, naltrexone is 50 mg p.o. given once a day, although there is evidence that higher doses may be effective (eg., 100 mg once daily) in some patients. Even with counseling, compliance rates with oral naltrexone are quite modest. An active ingredient slowly release formulation is also available. Dosage: 380 mg once monthly i.m. Naltrexone is contraindicated in patients with acute hepatitis or liver failure, and in patients who are opioid dependent contraindicated. Acamprosate, a synthetic analog of gamma-aminobutyric acid, p.o is in a dose of 2 g administered once daily. Acamprosate, the relapse rate and the frequency of drinking in patients who have a relapse lower. Currently being explored to what extent (an opioid antagonist) and topiramate can reduce the compulsive desire for alcohol nalmefene. For more information Alcoholics Anonymous Al-Anon Family Groups Life Ring Secular Recovery National Institutes for Alcohol Abuse and Recovery