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alcoholismA condition characterised by a pathologic pattern of alcohol use causing a serious impairment in social or occupational functioning; also defined by the Joint Committee of the National Council on Alcoholism and Drug Dependence & the American Society of Addiction Medicine as a “primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterised by … distortions in thinking, most notably denial.” A simpler, operational definition is persistent drinking that interferes with the person’s health, legal position, interpersonal relationships, or means of livelihood. Alcoholism is characterised by the regular intake of ≥75 g/day of alcohol.
Chronic effects Co-morbidity due to portal hypertension, hepatic failure, hyperoestrogenemia, infections (especially pneumonia) which may be due to alcohol-induced suppression of various immune defences, psychosocial disruption, transient hyperparathyroidism with decreased Ca2+, decreased Mg2+, osteoporosis.
Epidemiology (UK) 9% are heavy drinkers, 2% problem drinkers, 1% alcoholics.
Statistics (US) Alcohol causes half a million hospital admissions/year, 17,000 psychiatric admissions, 80% of all fire-related deaths, 65% of serious head injuries, 50% of homicides, 40% of RTAs/MVAs, 33% of divorces, 33% child abuse cases, 30% of fatal accidents, 30% of domestic accidents, 8 million working days lost, £1.6 billion annual cost to society.
Criteria for alcohol dependence
• Drinking >10 units/day
• Tolerance to effects of high blood alcohol concentration
• Withdrawal symptoms on stopping or reducing consumption
• Compulsion to continue drinking despite the problems it causes
• Abnormal lab tests.