Alcoholism (aka alcohol use disorder, alcohol dependence syndrome) is any drinking of alcohol that results in problems.

Alcohol is a drink that contains ethanol.

ETOH is shorthand for alcohol.

Source: Standard drinks

• 2 or more of the following is present:
  • Pt drinks large amounts over a long tie period
  • has difficulty cutting down
  • Acquiring and drinking alcohol takes up a great deal of time
  • Alcohol is strongly desired
  • usage results in not fulfilling responsibilities
  • Usage results in social problems
  • Usage results in health problems
  • Usage results in risky situations
  • Withdrawal occurs when stopping
  • Alcohol tolerance has occured w/ use
• Questionnaires
• Certain blood tests

Blood alcohol [level] (BAL, or blood alcohol concentration BAC) is the percentage of alcohol/ethanol in blood, mass per unit volume.  It is the most commonly used metric lf alcohol intoxication. The effects of blood alcohol at the various levels include:

• 0.01-0.03%, impairment is subtle. Behavior appears normal
• 0.03-0.06%, causes impaired concentration. Behavior includes decreased inhibition, talkativeness, joyousness, relaxation, and mild euphoria
• 0.06-0.09%, causes impaired reasoning, depth perception, peripheral vision, and glare recovery. Behavior includes blunted feelings, disinhibition, extroversion
• 0.1-0.2%, causes impaired reflexes, reaction time, gross motor control, staggering, slurred speech, temporary erectile dysfunction, possibility of temporary alcohol poisoning. Behavior includes over-expression, emotional swings, anger or sadness, boisterousness, decreased ilbido
• 0.2-0.3%, causes severe motor impairment, loss of consciousness, memory blackout. Behavior includes tupor, loss of understanding, impaired sensations, possibility of falling unconscious
• 0.3-0.4%, causes impaired bladder function, breathing, dysequilibrium, heart rate. Behavior includes severe CNS depressino, unconsciousness, possibility of death
• 0.4-0.5%, causes impaired breathing, heart rate, positional alcohol nystagus. Behavior includes general lack of behavior, unconsciousness, possibility of death
• >0.5%, causes high risk of poisoning, possibility of death

Binge drinking is any one time peak above 0.08%.

For motorists, it should be:

• In drivers with a L or P plate, truck/bus drivers, driving instructors, DUI drivers, 0% (i.e. prohibition)
• For taxi drivers, 0.02%
• For general motorists, 0.05%

• Can affect all part sof th ebody, but particularly affects the brain, heart, liver, pancreas, and imune system
• In the short term, it causes:
  • Intoxication
  • Dehydration
• In the long term, it causes:
  • Malnutrition
  • Cancers (esp of the respiratory and digestive system)
  • Neuropsychiatric impairment
  • Cardiovascular disease
  • Liver disease, Liver failure
  • Pancreatitis
  • Aging
  • Mental illness
  • Wernicke Korsakoff syndrome
  • Arrhythmia
• It stimulates insulin production, so can cause hypoglycemia in diabetics
• In pregnant women, FAS (fetal alcohol spectrum disorders) in the child

• Women, are generally more sensitive to alcohol's harmful physical and mental effects than men
• High stress levels
• Anxiety
• Inexpensive easily accessible alcohol
• Environmental factors, including social, cultura, and behavioral influences
• Genetics, w/ a Pt w/ a parent/sibling w/ alcoholism 3-4 times more likely to be alcohol themselves
• To prevent or improve Sx of withdrawal, continuing drinking or drinking partly

• Limit insult:
  • No more than 2 standard drinks on a day, to reduce the lifetime risk of harm form alcohol-related disease or injury. The lifetime risk of harm from drinking alcohol increases with the amount consumed
  • No more than 4 standard drinks on a single occassion, reduces the risk of alcohol-related injury injury arising from that occasion. The risk of alcohol related injury on a single occasion of drinking increases with the amount consumed
  • For kids<18yo, not drinking alcohol is the safest option. Kids<15yo are at the greatest risk of harm from drinking, and not drinkign alcohol is especially important. For kids 15-17yo, the safest option is to delay initiation of drinking for as long as possible
  • For women who are pregnant, planning a pregnancy, or breast feeding, not drinking is the safest option
  • A standard drink contains 10g of alcohol (equivalent to 12.5mL of pure alcohol)
• Prevention of alcoholism:
  • Regulating and limiting the sale of alcohol
  • Taxing alcohol to increase it's cost
  • Providing inexpensive Tx
• Alcohol detoxification, should be carefully controlled, due to the medical problems that can occur during withdrawal, including:
  • Benzodiazepines, e.g. diazepam, either given well admitted to a health care institutions, or occasionally whilst a Pt remains in the community w/ close supervision
• Group therapy or support groups, to help keep a Pt from returning to drinking, after detox support, e.g. Alcoholics Anonymous
• To prevent further drinking:
  • Acamprosate
  • Disulfiram
  • Naltrexone

Source: NHMRC

• Other addictions or mental illness may complicate Tx

• Low level of withdrawal may last for months following stopping

• Whilst there is evidence drinking a small amount of alcohol (1-2 standard drinks per day) can be protective against ischemic stroke for women and ischemic heart disease for men by 40%, the more you drink, the higher the risk of CVD (including HTN, stroke, cardiomyopathy) → Dr's rarely promote alcohol consumption with it given the many health concerns associated with it, and promote exercise and good nutrition to combat CVD. Also, cardio benefits of moderate consumption may be outweighed by risks of injuries, violence, fetal damage, liver disease, and certain forms of cancer
• It was previously divided into 2 types, alcohol abuse, and alcohol dependence
• 208m people with alcoholism worldwide (4.1% of population >15yo)
• In the USA, 7% of adults, and 2.8% of those 12-17yo are affected
• More common in males and young adults, becoming less common in middle and old age
• Least common in Africa at 1.1%
• Highest rate in Eastern Europe at 11%
• Directly resulted in 139k deaths annually, up from 112k deaths in 1990
• 5.9% of all deaths are due to alcohol
• Reduces a Pt's life expectancy by around 10 years
• Economic cost is $224bn per annum
• Many terms, some insulting, have been used to refer to alcoholics, including tippler, drunkard, dipsomaniac, souse

• Fetal alcohol syndrome
• Alcoholism
• Alcohol withdrawal syndrome