alcoholism

1. ALCOHOLISM

2. Alcoholism • Alcoholism is a chronic relapsing disease characterized by denial and inability to discontinue its use despite knowing its adverse consequences. • A person is considered to suffer from chronic alcoholism if his use of alcohol is up to such extent that it interferes with successful physical and social functioning.

3. The National Council on alcohol and drug dependency and The American Society of Addiction Medicine define 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."

4. The DSM-IVdefines alcohol abuse as repeated use despite recurrent adverse consequences. • It further defines alcohol dependence as alcohol abuse combined with tolerance, withdrawal, and an uncontrollable drive to drink.

5. CAUSES/RISK FACTORS Genetic factors- – It runs in families, children of alcoholics consume 4 times more than the children of non alcoholic.(Neumann, 2005). So if father is alcoholic, children are having greater risk. Psychological – ✓ Poor stress management skills, loneliness, desire to escape from reality, a sense of adventure, pleasure seeking. ✓ Emotionally immature, need for praise and appreciation.

6. Low frustration tolerance, feelings of inadequacy. • Psychological trauma during childhood as disturbed parent child relationship. • Inferiority, low self esteem, poor impulse control. • Disorders like depression, anxiety, phobia are prone to consume as an escape. • Personality disorders – persons - who have harsh super ego and who are self puncture turn to alcoholics to diminish their stress. • Childhood history of antisocial personality disorder. • Common in cyclothymiacs personalities.

7. Social factors – over crowding, influence of bad company, cinemas, literature. • Peer pressure, urbanization, religious reasons, unemployment. • Poor social support, fashion- a sign of modernity, social inadequacy, isolation. • Some settings as colleges and military settings where alcohol is considered as a status symbol. • To forget miseries and problems of life. • Unhealthy environment, sudden loss in property or closed ones. • Parental disharmony.

8. Occupational - heavy vehicle drivers, labourers, manual workers, Physical exhaustion or hard physical labour. • Economic causes : • ✓ Poverty. • ✓ Unemployment. • Professions like poets, painters, waiters, journalists, commercial, musicians, reporters are at greater risk. • Others: • ✓ Marital disharmony • ✓ Easy availability • ✓ Free time and boredom • ✓ Loneliness.

9. PATHOGENESIS IN ALCOHOLISM • Pre-alcoholic symptomatic phase : • In conventional social situations, an individual starts drinking alcohol but soon experiences tension relief. Gradually tolerance for tension decreases to such an extent that he resorts to alcohol almost daily. • Prodromal phase: • ✓ Sudden onset of black outs, signs of intoxication, loss of memory or events. • ✓ Seek occasions to drink, unknown to others with the fear that they will misjudge them.

10. ✓ Worrying about whether there will be enough to drink at a social gathering or not. ✓ Swallow the first two drinks very quickly. ✓ Guilt feelings about drinking behaviour. Crucial phase: ✓ Loss of control over drinking, increased isolation, decrease in sexual drive, centering the behaviour around alcohol. ✓ Improper nutrition, increased hostility towards spouse, increased jealousy feelings, suspicious nature. Chronic phase : • marked impairment in thinking process leading to alcoholic psychosis, delirium tremors occurs, develops rationalization and amenable to treatment. • -Casual to habitual drinker

11. DELLIOT and MERRILL • has described five stages through which a person has to pass till he became complete disorganized personality. • Morning drinking- Person starts drinking alcohol in morning and he feels it is necessary to push him throughout the day. • Escape drinking- It starts, when a person is not able to face reality of problems without the help of alcohol.

12. 3.Increasing consumption : Consumption of alcohol increases in amount leading to personal disorganization and decreased social value and feels that he cannot survive without alcohol. 4. Drinking and social functions: Drinking becomes absolute necessity in social gathering. 5. Extreme behaviour : drinks excessively and behave indiscriminately, i.g. Fighting, abusing, throwing away things, beating wife and children, absurd and dangerous behaviour etc.

13. TYPES OF DRINKERS • MODERATE : Moderately consuming alcohol and does not cause much problem. • PROBLEM : Drinking will impair health, affects peace of mind, family disruption, loss of reputation and drinking becomes the routine.

14. PROCESS OF ALCOHOLISM • EXPERIMENTAL: Due to peer pressure and curiousity, individual starts consuming alcohol. • RECREATIONAL : Gradually the frequency of • alcohol consumption • will increase as an enjoyment. • RELAXATIONAL : During weekends or on • holiday, it may work out to release the tension ,relax mind and to sedate the brain from painful emotions and promotes a sense of well being and pleasure. • COMPULSIVE: Person becomes addict to • overcome the discomfort of withdrawal symptoms.

15. IDENTIFYING THE ALCOHOLICS • ✓ Red palms and red nose • ✓ Improper gait • ✓ Decreased sensation and weakness in legs and feet. • ✓ Disorientation • ✓ Ring like opacity of cornea CLINICAL FEATURES • PHYSICAL SIGNS : • ✓ Indigestion- anorexia • ✓ Sweating • ✓ Unsteady gait • ✓ Malaise and tremors • ✓ Weakness in feet and legs • ✓ Pain in upper abdomen

16. PSYCHOLOGICAL SIGNS : • ✓ Blackouts- amnesia of events • ✓ Loss of self control • ✓ Outburst of aggressive behaviour • ✓ Insomnia COMPLICATIONS • A. Medical : • a. Gastro-intestinal Tract • ✓ Gastritis • ✓ Dyspepsia • Vomiting • ✓ Peptic ulcer • Cancer

17. Reflex esophagitis • Carcinoma of stomach and oesophagus, larynx, liver, colon • Fatty degeneration of the liver, interferes with absorption of vitamin B-complex • Cirrhosis of liver • Hepatitis, Jaundice • Liver cell carcinoma • Acute and chronic • pancreatitis

18. b. Cardiovascular System : • ✓ Cardiomyopathy • ✓ Hypertension • ✓ Heart failure or stroke • ✓ High risk for myocardial infarction. • c. Blood: • ✓ Folic acid deficiency anaemia • ✓ Decreased WBC production causes infections

19. d. Nervous System • ✓ Confusion, numbness of hands, feet, disordered thinking • ✓ Depression, depresses vital centers of the brain • ✓ Peripheral Neuropathy, • ✓ Dementia • ✓ Epilepsy • ✓ Head injury • ✓ Cerebellar degeneration • ✓ Wernicke's encephalopathy coma

20. e. Hormonal : • ✓ Hypoglycemia f. Muscle : • ✓ Peripheral muscle weakness • ✓ Wasting of muscles g. Bones : • ✓ Interferes with the production of bones • ✓ Thinning of bones, osteoporosis • ✓ Fractures

21. i. Reproductive System : • ✓ Sexual dysfunction in male • ✓ Failure of ovulation in female • ✓ Interruption in menstruation • j. Nutritional Deficiency Diseases : • ✓ PEM • ✓ B complex deficiency-Pellagra, Beriberi • k. Pregnancy: • ✓ Fetal abnormalities • ✓ Developmental disabilities- Mental retardation, Growth retardation • ✓ Low birth weight • ✓ Still birth • ✓ Birth defects • ✓ Foetal alcohol syndrome

22. Social Complications : • ✓ Domestic abuse, divorce, poor performance in school and at work. • ✓ Prone for motor vehicle accidents, susceptible for accidental injuries, violence acts,e.g. murder, reduced productivity.