(Redirected from Alcohol addiction)
'Alcoholism' is a term with multiple and sometimes conflicting definitions, but with no formal recognition of the divergence of meaning. In common and historical usage, alcoholism refers to any condition that results in the continued consumption of alcoholic beverages despite the health problems and negative social consequences it causes. Medical definitions describe alcoholism as a
disease which may result in a persistent difficulty in controlling alcohol consumption. Alcoholism may also refer to a preoccupation with or compulsion toward the consumption of alcohol and/or an impaired ability to recognize the negative effects of excessive alcohol consumption. Although not all of these definitions specify current and on-going use of alcohol as a qualifier, some do, as well as remarking on the long-term effects of consistent, heavy alcohol use, including
dependence and symptoms of
withdrawal.
While the ingestion of alcohol is, by definition, necessary to develop alcoholism, the use of alcohol does not predict the development of alcoholism. The quantity, frequency and regularity of alcohol consumption required to develop alcoholism varies greatly from person to person. In addition, although the biological mechanisms underpinning alcoholism are uncertain, some risk factors, including
social environment,
emotional health and
genetic predisposition, have been identified.
"King Alcohol and his Prime Minister" circa 1820
Definitions and Terminology
The definitions of alcoholism and related terminology vary significantly between the medical community, treatment programs, and the general public.
Medical Definitions
The
Journal of the American Medical Association defines alcoholism 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."
[1]
The
DSM-IV (the standard for diagnosis in psychiatry and psychology) defines '''alcohol abuse''' as repeated use despite recurrent adverse consequences.
[''APA Dictionary of Psychology'', 1st ed., Gary R. VandenBos, ed., Washington: American Psychological Association, 2007 ] ; further defining '''alcohol dependence''' as ''alcohol abuse'' combined with
tolerance,
withdrawal, and an uncontrollable drive to drink.
(See ''DSM diagnosis'' below.)
According to the ''APA Dictionary of Psychology'', alcoholism is the popular term for ''alcohol dependence''.
Note that there is debate whether ''dependence'' in this use is physical (characterised by withdrawal), psychological (based on
reinforcement), or both.
Terminology
Many terms are applied to a drinker's relationship with alcohol. ''Use'', ''misuse'', ''heavy use'', ''abuse'', ''addiction'', and ''dependence'' are all common labels used to describe drinking
habits, but the actual meaning of these words can vary greatly depending upon the context in which they are used. Even within the medical field, the definition can vary between areas of specialization. The introduction of politics and religion further muddles the issue.
'''Use''' refers to simple use of a substance. An individual who drinks any alcoholic beverage is ''using'' alcohol. '''Misuse''', '''problem use''', and '''heavy use''' do not have standard definitions, but suggest consumption of alcohol beyond the point where it causes physical, social, or moral harm to the drinker. The definitions of social and moral harm are highly subjective and therefore differ from individual to individual.
Within politics, '''abuse''' is often used to refer to the illegal use of any substance. Within the broad field of medicine, ''abuse'' sometimes refers to use of prescription medications in excess of the prescribed dosage, sometimes refers to use of a prescription drug without a prescription, and sometimes refers to use that results in long-term health problems. Within religion, ''abuse'' can refer to any use of a poorly regarded substance. The term is often avoided because it can cause confusion with audiences that do not necessarily share a single definition.
'''Remission''' is often used to refer to a state where an alcoholic is no longer showing symptoms of alcoholism. The
American Psychiatric Association considers remission to be a condition where the physical and mental symptoms of alcoholism are no longer evident, regardless of whether or not the person is still drinking. They further subdivide those in remission into '''early''' or '''sustained''', and '''partial''' or '''full'''. Others (most notably
Alcoholics Anonymous) use the term '''recovery''' to describe those who have completely stopped consumption of alcohol.
Epidemiology
Substance use disorders are a major
public health problem facing many countries. "The most common substance of abuse/dependence in patients presenting for treatment is alcohol."
[Gabbard: "Treatments of Psychiatric Disorders". Published by the American Psychiatric Association: 3rd edition, 2001, ISBN 0-88048-910-3] In the United Kingdom, the number of 'dependent drinkers' was calculated as over 2.8 million in 2001.
[Cabinet Office Strategy Unit Alcohol misuse: How much does it cost? September 2003]
Within the medical community, there is broad consensus regarding alcoholism as a disease state. Outside the medical community, there is considerable debate regarding the
Disease Theory of Alcoholism. Proponents argue that any structural or functional disorder having a predictable course, or progression, should be classified as a disease. Opponents cite the inability to pin down the behavioral issues to a physical cause as a reason for avoiding classification.
A 2002 study
[2] by the
National Institute on Alcohol Abuse and Alcoholism surveyed a group of 4,422 adult alcoholics and found that after one year some were no longer alcoholics, with the breakdown as follows:
★ 25% still dependent
★ 27.3% in partial remission (some symptoms persist)
★ 11.8% asymptomatic drinkers (consumption increases chances of relapse)
★ 35.9% fully recovered — made up of 17.7% low-risk drinkers plus 18.2% abstainers.
Identification and diagnosis
Multiple tools are available to those wishing to conduct screening for alcoholism. Identification of alcoholism may be difficult because there is no detectable physiologic difference between a person who drinks frequently and a person with the condition. Identification involves an objective assessment regarding the damage that imbibing alcohol does to the drinker's life compared to the subjective benefits the drinker perceives from consuming alcohol. While there are many cases where an alcoholic's life has been significantly and obviously damaged, there are always borderline cases that can be difficult to classify.
''Addiction Medicine'' specialists have extensive training with respect to diagnosing and treating patients with alcoholism.
Screening
Several tools may be used to detect a loss of control of alcohol use. These tools are mostly
self reports in questionnaire form. Another common theme is a score or tally that sums up the general severity of alcohol use.
★ 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.
:The CAGE questionnaire, among others, has been extensively validated for use in identifying alcoholism. It is not valid for diagnosis of other substance use disorders, although somewhat modified versions of the CAGE are frequently implemented for such a purpose.
★ The
Alcohol Dependence Data Questionnaire[3] is a more sensitive diagnostic test than the CAGE test. It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol use.
★ The
Michigan Alcohol Screening Test (MAST)
[4] 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.
★ The
Alcohol Use Disorders Identification Test (AUDIT) is a screening questionnaire developed by the
World Health Organization. This test is unique in that it has been validated in six countries and is used internationally.
[5] Like the CAGE questionnaire, it uses a simple set of questions - a high score earning a deeper investigation.
★ The
Paddington Alcohol Test (PAT) was designed to screen for alcohol related problems amongst those attending
Accident and Emergency departments. It concords well with the AUDIT questionnaire but is administered in a fifth of the time.
[6]
★ A number of free websites provide anonymous self-screening for harmful or hazardous alcohol use, including
AlcoholScreening.org and
this online version of AUDIT.
Genetic predisposition testing
Psychiatric geneticists John I. Nurnberger, Jr., and Laura Jean Bierut indicate that alcoholism does not have a single cause—including genetic—but that genes do play an important role "by affecting processes in the body and brain that
interact with one another and with an individual's life experiences to produce protection or susceptibility." They also report that less than a dozen alcoholism-related genes have been identified, but that more likely await discovery.
[7]
At least one genetic test
[8] exists for an allele that is correlated to alcoholism and opiate addiction. Human dopamine receptor genes have a detectable variation referred to as the DRD2 TaqI polymorphism. Those who possess the
A1 allele (variation) of this polymorphism have a small but significant tendency towards addiction to opiates and endorphin releasing drugs like alcohol.
[9] Although this allele is slightly more common in alcoholics and opiate addicts, it is not by itself an adequate predictor of alcoholism, and some researchers argue that evidence for DRD2 is contradictory.
Some writers posit that alcohol was discovered to be a replacement for polluted drinking water in early urban societies. In these conditions, alcohol's antibacterial properties offset its health risk, and the slow death of cirrhosis of the liver was preferred to an early death from waterborne disease. This caused a selection pressure on the genes of humans who had abandoned the hunter-gatherer lifestyle towards people with genes which were not prone to over consumption and drunkenness. Over generations, the descendants of these first farmers and urban dwellers became dominated by individuals who could drink more beer more often. This theory explains why some groups who continued a predominately hunter-gatherer culture, such as Native Americans or Australian Aborigines, have such high rates of alcoholism today
[10].
DSM diagnosis
The
DSM-IV diagnosis of alcohol dependence represents one approach to the definition of alcoholism. In part this is to assist in the development of research protocols in which findings can be compared with one another. According to the DSM-IV, an alcohol dependence diagnosis is:
Urine and blood tests
There are reliable tests for the actual use of alcohol, one common test being that of
blood alcohol content (BAC). These tests do not differentiate alcoholics from non-alcoholics; however, long-term heavy drinking does have a few recognizable effects on the body, including:
★
Macrocytosis (enlarged
MCV)
1
★ Elevated
GGT2
★ Moderate elevation of
AST and
ALT and an AST:ALT ratio of 2:1.
★ High
carbohydrate deficient transferrin (CDT)
Effects
The primary effect of alcoholism is to encourage the sufferer to drink at times and in amounts that are damaging. The secondary damage caused by an inability to control one's drinking manifests in many ways.
It is common for a person suffering from alcoholism to drink well after physical health effects start to manifest. The physical health effects associated with alcohol consumption are described in
Alcohol consumption and health, but may include
cirrhosis of the liver,
pancreatitis,
polyneuropathy,
alcoholic dementia, heart disease, increased chance of cancer, nutritional deficiencies,
sexual dysfunction, and death from many sources.
Social effects
The social problems arising from alcoholism can be significant. Being drunk or hung over during work hours can result in
loss of employment, which can lead to financial problems including the loss of living quarters. 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. An alcoholic's behavior and mental impairment while drunk can profoundly impact surrounding family and friends, possibly leading to
marital conflict and
divorce, or contributing to
domestic violence. This can contribute to lasting damage to the emotional development of the alcoholic's children, even after they reach adulthood. The alcoholic could suffer from loss of respect from others who may see the problem as self-inflicted and easily avoided.
Alcohol withdrawal
Alcohol withdrawal differs significantly from withdrawal from other drugs in that it can be directly fatal. While it is possible for
heroin addicts, for instance, to die from other health problems made worse by the strain of withdrawal, an otherwise healthy alcoholic can die from the direct effects of withdrawal if it is not properly managed. Heavy consumption of alcohol reduces the production of
GABA, which is a
neuroinhibitor. An abrupt stop of alcohol consumption can induce a condition where neither alcohol nor GABA exists in the system in adequate quantities, causing uncontrolled firing of the synapses. This manifests as hallucinations, shakes, convulsions, seizures, and possible heart failure, all of which are collectively referred to as
delirium tremens. All of these withdrawal issues can be safely controlled with a medically supervised
detox.
Treatments
Treatments for alcoholism are quite varied because there are multiple perspectives for the condition itself. Those who approach alcoholism as a medical condition or disease recommend differing treatments than, for instance, those who approach the condition as one of social choice.
Most treatments focus on helping people discontinue their alcohol intake, followed up with life training and/or social support in order to help them resist a return to alcohol use. Since alcoholism involves multiple factors which encourage a person to continue drinking, they must all be addressed in order to successfully prevent a relapse. 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. The treatment community for alcoholism typically supports an abstinence-based
zero tolerance approach; however, there are some who promote a harm-reduction approach as well.
Effectiveness
The effectiveness of alcoholism treatments varies widely. When considering the effectiveness of treatment options, one must consider the success rate based on those who enter a program, not just those who complete it. Since completion of a program is the qualification for success, success among those who complete a program is generally near 100%. It is also important to consider not just the rate of those reaching treatment goals but the rate of those relapsing. Results should also be compared to the roughly 5% rate at which people will quit on their own.[11] Based on information from Dr. Mark Willenbring of the National Institute on Alcohol Abuse and Alcoholism, the February 2007 issue of ''Newsweek'' reported that "A year after completing a rehab program, about a third of alcoholics are sober, an additional 40 percent are substantially improved but still drink heavily on occasion, and a quarter have completely relapsed."[12]
Detoxification
Main articles: Alcohol detoxification
Alcohol detoxification or 'detox' for alcoholics is an abrupt stop of alcohol drinking coupled with the substitution of drugs that have similar effects to prevent alcohol withdrawal.
Detoxification treats the physical effects of prolonged use of alcohol, but does not actually treat alcoholism. After detox is complete, relapse is likely without further treatment. These rehabilitations (or 'rehabs') may take place in an inpatient or outpatient setting.
Group therapy and psychotherapy
After detoxification, 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.
The mutual-help group-counseling approach is one of the most common ways of helping alcoholics maintain sobriety. Many organizations have been formed to provide this service, including Alcoholics Anonymous, LifeRing Secular Recovery, Rational Recovery, Smart Recovery, Al-Anon/Alateen, and Women For Sobriety.
Rationing and moderation
Rationing and moderation programs such as Moderation Management and The HAMS Harm Reduction Network do not mandate complete abstinence. While most alcoholics are unable to limit their drinking in this way, some return to moderate drinking. A 2002 U.S. study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed that 17.7% of individuals diagnosed as alcohol dependent more than one year prior returned to low-risk drinking.
Medications
Although not necessary for treatment of alcoholism, a variety of medications may be prescribed as part of treatment. Some may ease the transition to sobriety, while others cause physical hardship to result from the use of alcohol. In most cases the desired effect is to have an alcoholic abstain from drinking.
★ ''Antabuse'' (disulfiram) prevents the elimination of acetaldehyde, a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many hang over symptoms from alcohol use. The overall effect is severe discomfort when alcohol is ingested: an extremely fast acting and long lasting uncomfortable hang over. This discourages an alcoholic from drinking in significant amounts while they take the medicine. Heavy drinking while on antabuse can cause severe illness and death.
★ ''Naltrexone'' is a competitive antagonist for opioid receptors, effectively blocking our ability to use endorphins and opiates. Naltrexone is used in two very different forms of treatment. The first treatment uses naltrexone to decrease cravings for alcohol and encourage abstinence. The other treatment, called pharmacological extinction, combines naltrexone with normal drinking habits in order to reverse the endorphin conditioning that causes alcohol addiction. Naltrexone comes in two forms. Oral naltrexone, originally but no longer available as the brand ReVia, is a pill form and must be taken daily to be effective. Vivitrol is a time-release formulation that is injected in the buttocks once a month.
★ ''Piracetam'' appears to be effective in treating alcoholism or its symptoms in clinical studies.[13][14][15][16][17][18]. Piracetam appears to reduce levels of lipofuscin in the rat brain. [19] (Lipofuscin accumulation is common symptom of aging and alcoholism).
★ ''Acamprosate'' (also known as Campral) is thought to stabilize the chemical balance of the brain that would otherwise be disrupted by alcoholism. The Food and Drug Administration (FDA) approved this drug in 2004, saying "While its mechanism of action is not fully understood, Campral is thought to act on the brain pathways related to alcohol abuse...Campral proved superior to placebo in maintaining abstinence for a short period of time...[20]" While effective alone,[21] it is often paired with other medication treatments like naltrexone with great success.[22] Acamprosate reduces glutamate release. The COMBINE study was unable to determine the presence of efficacy for Acamprosate.[23]
★ ''Sodium oxybate'' is the sodium salt of gamma-hydroxybutyric acid (GHB). It is used for both acute alcohol withdrawal and medium to long-term detoxification. This drug enhances GABA neurotransmission and reduces glutamate levels. It is used in Italy in small amounts under the trade name Alcover.
★ ''Baclofen'' has been shown in animal studies and in small human studies to enhance detoxification.This drug acts as a GABA B receptor agonist and this may be beneficial.
Pharmacological extinction
Pharmacological extinction is the use of opioid antagonists like naltrexone combined with normal drinking habits to eliminate the craving for alcohol.[Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism] The simple description is that the use of opioid antagonists reverses the effect that alcohol consumption has on alcohol addiction
While standard naltrexone treatment uses the drug to curb craving and enforce abstinence, pharmacological extinction targets the endorphin-based neurological conditioning. Our behaviors become conditioned when our neurons are bathed in endorphins following that action. Conversely, we receive negative reinforcement when we perform that action and yet do not get our endorphins. By having the alcoholic go about their normal drinking habits (limited only by safety concerns), and while preventing the endorphins from being released by the alcohol, the pull to drink is eliminated over a period of about three months. This allows an alcoholic to give up drinking as being sensibly unbeneficial. The effects persist after the drug is discontinued, but the addiction can return if the person drinks without first taking the drug. This treatment is also highly unusual in that it works better if the patient does not go through detoxification before starting it. Clinical studies have shown this treatment to allow 78-87% of inductees to reduce their drinking below levels dangerous to health, and allow 25% of inductees to achieve complete abstinence. Follow-up studies indicate an overall 50% relapse rate over five years, and 2% relapse rate for those who continue to take naltrexone before drinking.
There is a lot of professional resistance to this treatment for two reasons. Studies have demonstrated that controlled drinking for alcoholics was not a useful treatment technique.[27] Other studies have also shown naltrexone to be of questionable value in supporting abstinence alone.[28][29][30] The individual failure of these two separate treatments is inappropriately presumed to indicate that their use in combination is equally ineffective.
Nutritional therapy
Preventative treatment of alcohol complications includes long-term use of a multivitamin as well as such specific vitamins as B12 and folate.
While nutritional therapy is not a treatment of alcoholism itself, it treats the difficulties that can arise after years of heavy alcohol use. Many alcohol dependents have insulin resistance syndrome, a metabolic disorder where the body's difficulty in processing sugars causes an unsteady supply to the blood stream. While the disorder can be diminished by a hypoglycemic diet, this can affect behavior and emotions, side-effects often seen among alcohol dependents in treatment. The metabolic aspects of such dependence are often overlooked, causing poor treatment outcomes.[31]
Societal impact
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, and secondary treatment costs. Alcohol use is a major contributing factor for head injuries, motor vehicle accidents, violence, and assaults. Beyond money, there is also the pain and suffering of the all individuals besides the alcoholic affected. For instance, alcohol consumption by a pregnant woman can lead to Fetal alcohol syndrome,[32] an incurable and damaging condition.[33]
Estimates of the economic costs of alcohol abuse, collected by the World Health Organization, vary from one to six per cent of a country's GDP.[34] One Australian estimate pegged alcohol's social costs at 24 per cent of all drug abuse costs; a similar Canadian study concluded alcohol's share was 41 per cent.[35]
A study quantified the cost to the UK of ''all'' forms of alcohol misuse as £18.5–20 billion annually (2001 figures).[36]
Stereotypes
Depiction of a
wino or town drunk
Stereotypes of alcoholics are often found in fiction and popular culture. Common examples include the 'town drunk' or the portrayal of certain nationalities as alcoholics. In modern times, the recovery movement has led to more realistic depictions of problems that stem from heavy alcohol use. Authors such as Charles R. Jackson and Charles Bukowski describe their own alcohol addiction in their writings. Films like ''Days of Wine and Roses'', ''My Name is Bill W.'', ''Arthur'', ''Leaving Las Vegas'' chronicle similar stories of alcoholism.
Politics and public health
Because alcohol use disorders are perceived as impacting society as a whole, governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism. The World Health Organization, the European Union and other regional bodies are working on alcohol action plans and programs.
Organizations working with those suffering from alcoholism include:
★ Alcoholics Anonymous (AA)
★ HAMS Harm Reduction Network
★ International Organisation of Good Templars (IOGT)
★ LDS Family Services
★ LifeRing Secular Recovery (LifeRing)
★ Moderation Management (MM)
★ Narcotics Anonymous (NA), Alcohol is a drug, although not a narcotic.
★ Rational Recovery (RR)
★ Secular Organizations for Sobriety (SOS)
★ Smart Recovery (Self Management And Recovery Training - SMART)
★ Women For Sobriety (WFS)
★ Online Addiction Recovery
See also
★ Adult Children of Alcoholics
★ Alcohol consumption and health
★ Alcohol-related traffic crashes
★ Alcohol tolerance
★ Drunkenness
★ Ethanol Metabolism biochemical discussion of alcohol metabolism
★ List of deaths through alcohol
★ List of iconic drinkers
★ Substance abuse
★ Wernicke-Korsakoff syndrome
★ Medical diagnostics to test for alcohol use
★
★ Blood alcohol content
★
★ Full blood count
★
★ Liver function tests
References
1. The definition of alcoholism, The Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism, The Journal of the American Medical Association, 268(8), August 26, 1992
2. National Institute on Alcohol Abuse and Alcoholism 2001-2002 Survey Finds That Many Recover From Alcoholism Press release 18 January 2005.
3. Alcohol Dependence Data Questionnaire (SADD)
4. Michigan Alcohol Screening Test (MAST)
5. AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care
6. Detection of alcohol misusing patients in accident and emergency departments: the Paddington alcohol test (PAT), , SG, Smith, Journal of Accident and Emergency Medicine,
7. Nurnberger, Jr., John I., and Bierut, Laura Jean. "Seeking the Connections: Alcoholism and our Genes." ''Scientific American'', Apr2007, Vol. 296, Issue 4.
8. New York Daily News (William Sherman) Test targets addiction gene 11 February 2006
9. Ulf Berggren, Claudia Fahlke, Erik Aronsson, Aikaterini Karanti, Matts Eriksson, Kaj Blennow, Dag Thelle, Henrik Zetterberg and Jan Balldin The TaqIA DRD2 A1 Allele Is Associated with Alcohol-Dependence although its Effect Size Is Small ''Alcohol and Alcoholism'' 2006 41(5):479-485; doi:10.1093/alcalc/agl043
10. A synopsis of the idea can be found in popular science writer Steven Berlin Johnson's The Ghost Map, Penguin Group (2006) pgs 103-104
11. Spontaneous Recovery in Alcoholics: A Review and Analysis of the Available Research, by R. G. Smart Drug and Alcohol Dependence, Vol. 1, 1975-1976, p. 284.
12. Adler, Jerry; Underwood, Anne; Kelley, Raina; Springen, Karen; Breslau, Karen. "Rehab Reality Check" ''Newsweek'', 2/19/2007, Vol. 149 Issue 8, p44-46, 3p, 4c
13. Skondia, V. & Kabes, J., "Piracetam in alcoholic psychoses: a double-blind, crossover, placebo controlled study", ''J Int Med Res'' '13', (1985) pp.185-187.
14. S Kalmár, Adjuvant therapy with parenteral piracetam in alcohol withdrawal delirium, ''Orv Hetil'' (2003) '144': pp.927-30.
15. Buranji I, Skocilic Z, Kozaric-Kovacic D. "Cognitive function in alcoholics in a double-blind study of piracetam, ''Lijec Vjesn'' 1990 Mar-Apr;112(3-4):111-4.
16. Dencker SJ, Wilhelmson G, Carlsson E, Bereen FJ. "Piracetam and chlormethiazole in acute alcohol withdrawal: a controlled clinical trial." ''J Int Med Res'' 1978;6(5):395-400.
17. Meyer JG, Forst R, Meyer-Wahl L. "Course of alcoholic predelirium during treatment with piracetam: results of serial psychometric tests (author's transl)", ''Dtsch Med Wochenschr'' 1979 Jun 22;104(25):911-4
18. Binder S, Doddabela P. "The efficacy of Piracetam on the mental functional capacity of chronic alcoholics (author's transl)", ''Med Klin'' 1976 Apr 23;71(17):711-6
19. Paula-Barbosa, M. ''et al'', "The effects of Piracetam on lipofuscin of the rat cerebellar and hippocampa; neurons after long-term alcohol treatment and withdrawal", ''Alcoholism: Clinical and Experimental Research'' '15', (1991) pp. 834-838.
20. FDA Approves New Drug for Treatment of Alcoholism
21. Effect of oral acamprosate on abstinence in patients with alcohol dependence in a double-blind, placebo-controlled trial: The role of patient motivation.
22. COMBINED ACAMPROSATE AND NALTREXONE, WITH COGNITIVE BEHAVIOURAL THERAPY IS SUPERIOR TO EITHER MEDICATION ALONE FOR ALCOHOL ABSTINENCE: A SINGLE CENTRES' EXPERIENCE WITH PHARMACOTHERAPY.
23. Naltrexone or Specialized Alcohol Counseling an Effective Treatment for Alcohol Dependence When Delivered with Medical Management
24. ContrAl Clinics ContrAl Results
25. The Sinclair Method
26. University of Pennsylvania Health System
27. Pendery et al. Controlled drinking by alcoholics? New findings and a reevaluation of a major affirmative study. ''Science'' 1982 Jul 9;217 (4555):169-75
28. Renault, P.F. (1978) Treatment of heroin-dependent persons with antagonists: Current status. Bulletin on Narcotics 30: 21-29 ¶ Renault, P.F. (1980) Treatment of heroin dependent persons with antagonists: Current status. In: Naltrexone: Research Monograph 28, Willett, R.E., and Barnett, G., (eds.), Washington, DC: National Institute of Drug Abuse, 11 22.
29. O'Malley, S.S., Jaffe, A.J., Rode, S., and Rounsaville, B.J. (1996) Experience of a “slip'' among alcoholics treated with Naltrexone or placebo. American Journal of Psychiatry, 153(2): 281-283.
30. Maxwell, S., and Shinderman, M.S. (1997) Naltrexone in the treatment of dually-diagnosed patients. ''Journal of Addictive Diseases'' 16: A27, 125, 1997 ¶ Maxwell, S., and Shinderman M.S. (2000) Use of Naltrexone in the treatment of alcohol use disorders in patients with concomitant severe mental illness. ''Journal of Addictive Diseases'' 19:61-69.
31. The Hypoglycemic Health Association of Australia
32. CDC. (2004). ''Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis''. Can be downloaded at http://www.cdc.gov/fas/faspub.htm
33. Streissguth, A. (1997). ''Fetal Alcohol Syndrome: A Guide for Families and Communities''. Baltimore: Brookes Publishing. ISBN 1-55766-283-5.
34. World Health Organization Global Status Report on Alcohol 2004 Global Status Report on Alcohol 2004 accessed 3 January 2007
35. World Health Organization Global Alcohol Database [1] 3 January 2007 search for ''Economic cost of alcohol consumption''
36. BBC Q&A: The costs of alcohol 19 September 2003
Further reading
★ Berry, Ralph E.; Boland James P. ''The Economic Cost of Alcohol Abuse'' The Free Press, New York, 1977 ISBN 0-02-903080-3
★ Royce, James E. and Scratchley, David ''Alcoholism and Other Drug Problems'' Free Press, March 1996 ISBN-10: 0-684-82314-4 ISBN-13: 978-0-684-82314-0
★ Valliant, George E., ''The Natural History of Alcoholism Revisited, Harvard University Press, May 1995 ISBN-10: 0-674-60378-8 ISBN-13: 978-0-674-60378-3
★ Pence, Gregory, "Kant on Whether Alcoholism is a Disease," Ch. 2, The Elements of Bioethics, McGraw-Hill Books, 2007 ISBN-10: 0-073-13277-2.
★ Milam, Dr. James R. and Ketcham, Katherine ''Under The Influence: A Guide to the Myths and Realities of Alcoholism.'' Bantam, 1983, ISBN 0-553-27487-2
★ Warren Thompson, MD, FACP. “Alcoholism.” Emedicine.com, June 6, 2007. Retrieved 2007-09-02.
External links
★ Baldwin Research Institute Independent Research on Alcoholism and Drug Addiction
★ Invited Interview from the Oxford Journal of Medicine on the use of Naltrexone to treat alcoholism
★ National Institute on Alcohol Abuse and Alcoholism (NIAAA)
★ University of Minnesota Impulse Control Disorders Clinic Provides useful information and resources for patients and their families, including free questionnaire-based rating scales that patients can use to assess and track the severity of their condition.
★ Alcohol and Drug Usage Self-Tests: CAGE Questionnaire for Alcohol Dependence, Michigan Alcohol Screening Test (MAST), and Drug Abuse Screening Test (DAST)
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