Alcohol Abuse: Early Identification and Treatment - Research Paper Example

Substance-related disorders- alcoholism Causes of substance-related disorders, especially alcoholism Biological factors Familial and genetic influences: Studies with humans, twin, family and adoption cases have revealed that certain people may be genetically vulnerable to substance abuse (Barlow & Durand, 2004). Most of these studies were on alcohol abuse. The studies also revealed that while use of illegal drugs is primarily influenced by environment, abuse and dependence is influenced by various genetic factors. However no particular gene has been attributed to this. When compared to non-alcoholics, the sons of alcoholics may be more sensitive to alcohol when it is first ingested and then become less sensitive to its effects as the hours pass after drinking (Barlow & Durand, 2004). Increased tolerance for alcohol is genetically mediated (Alcohol abuse, Mental health channel). Neurobiological influences: People use illegal drugs and alcohol for their pleasurable experiences. Human brain has a pleasure pathway that mediates our experience of reward. Researchers have proposed the domaminergic system and its opioid-releasing neurons as the pleasurable pathway. This begins in the midbrain ventral segmental area and then work its way forward through the nucleus accumbens and on the frontal vortex (Barlow & Durand, 2004). The substances activate this center and impart feelings of pleasure. Drugs like amphetamine and cocaine directly activate the dopaminergic system. Opiates inhibit GABA which inturn stops the GABA neurons from inhibiting dopamine, thus making dopamine more available in the reward center (Barlow & Durand, 2004). Other than imparting pleasures, these drugs also have anxiolytic effect and remove unpleasant experiences like pain and feelings of illness. Alcohol has a strong anxiolytic effect. The anxiolytic effects are because of the drugs are due to their involvement with septal/hippocampal system which have a large number of GABA-sensitive neurons (Barlow & Durand, 2004). Many of the drugs enhance the activity of GABA in this region and inhibit the brains normal reaction to anxiety-producing situations. Some studies have pointed to a relation between certain brain wave patterns and an increased risk for alcoholism (Barlow & Durand, 2004). Racial influences: Chinese, Japanese, and Koreans have deficiency or absence of alcohol dehydrogenase and hence tend to drink less and are at lower risk for alcoholism (Alcohol abuse, Mental health channel). This is because, the inability to metabolize alcohol in these people causes various symptoms like vomiting, flushing, and increased heart rate, thus making drinking difficult. Native Americans tend to drink more because they do not get intoxicated quickly. 2. Psychological factors Positive reinforcement: People take psychoactive substances to recapture the pleasure they experience during consumption. Also, the social contexts for drug taking may encourage its use (Barlow & Durand, 2004). Negative reinforcement: Some people may initiate and continue to use illicit drug not for their pleasurable experiences but to escape from unpleasant experiences in their lives. Drugs like opiates decrease physical pain. Alcohol relieves from stress, panic and anxiety. Sexually abused people are more likely to abuse alcohol. Children who are lonely or crying a lot or bring tense are more likely to abuse substances (Barlow & Durand, 2004). 3. Cognitive factors Some people may drink alcohol because they think that it improves social behavior and their cognitive and motor abilities or they think that it makes them feel good. In those who are addicted to alcohol, there is a cognitive phenomenon called alcohol myopia which is a state of short sightedness in which superficially understood, immediate aspects of experience have a disproportionate influence on behavior and emotion (Barlow & Durand, 2004). This probably is one of the reasons as to why people continue to drink even when they know excessive drinking can have severe negative consequences. Those under the influence of alcohol are not in a position to evaluate appropriately the risks involved in the consumption of alcohol (Barlow & Durand, 2004). 4. Social factors People get introduced to drugs by many social means like friends, media, etc. 5. Family influence Family violence and having several close blood relatives who are alcohol dependent are important risk factors. Also, lack of parental monitoring, drastic family conflicts, and poor parent-child relationships can contribute to alcohol abuse, especially in adolescents (Alcohol abuse, Mental health channel). 6. Mental conditions Children with conduct disorders, poor socialization, poor academic performance and ineffective coping skills are prone to alcoholism (Alcohol abuse, Mental health channel). Metabolism of alcohol Alcohol or ethanol is absorbed from the gastrointestinal tract, mainly the stomach. It then enters blood stream and goes to all the tissues. It undergoes oxidation in the liver. The first step in the oxidation is conversion of ethanol to acetaldehyde and this is catalyzed by alcohol dehydrogenase. During this process, NADH (NAD, nicotinamide adenine dinucleotide) is released. The acetaldehyde is further oxidized to acetic acid which then enters the citric acid cycle and metabolized to carbondioxide and water. NADH is used up in the conversion of pyruvic acid to lactic acid, in the synthesis of lipids and in the electron transport chain (Paton, 2005). Most of the damage to cells caused by ethanol is due to acetaldehyde and NADH. Acetaldehyde causes damage due to immune response and increased NADH causes altered NADH/NAD ratio leading to increased oxygen consumption and hypermetabolic state (Tome, 2004). Effects of alcohol The effects of alcohol are dependent on a variety of factors, like persons size, weight, age, and sex, and amount of food and alcohol consumed. The effects can be short term or long term. Short term effects: Alcohol causes disinhibition and can make a person perform aggressive acts including domestic violence and child abuse. It causes dizziness, talkativeness, slurred speech, disturbed sleep, nausea, and vomiting. It significantly impairs the judgment and coordination required to drive a car safely. After consumption of large quantities of alcohol, the person can suffer from hang-over which consists of headache, nausea, thirst, dizziness, and fatigue (Alcohol, Drugfree.org). Long term effects: The main long-term effect is addiction. Addiction leads to long term consumption of heavy doses of alcohol which can lead to damage of vital organs like liver and brain. Addiction also causes withdrawal symptoms like severe anxiety, tremors, hallucinations and convulsions. Consumption of alcohol during pregnancy can cause defects in the fetus known as fetal alcohol syndrome (Alcohol, Drugfree.org). Management of alcoholism 1. Early identification and treatment: It is important to identify alcoholism early to get the best out of treatment 2. Motivating patients: This is the key to successful recovery. This can be done by giving supportive information and help rather than confrontation. 3. Abstinence is a must advice for those who are already alcohol dependence. This is because alcoholics seldom revert to normal drinking (Brdley, 1992). 4. In those who cannot have control over drinking and are not alcohol dependent, decreasing the quantity of drinks per day to just 2 per day can reduce morbidity significantly (Brdley, 1992). 5. Detoxification and treatment of withdrawal symptoms with benzodiazepines either inpatient or on out-patient basis. Beta-blockers may be useful adjuncts to benzodiazepine therapy. 6. Treatment programs: There are many treatment programs like behavioral, psychotherapeutic, aversion, pharmacologic and self-help. The kind of treatment program to be instituted depends on the person. Behavior therapy involves cognitive behavioral therapy and motivational enhancement therapy. 7. Drugs like disulfiram and naltrexone are useful in the management of chronic alcoholics with dependency. Disulfiram actually has limited role in rehabilitation. Interaction between this drug and alcohol can lead to various symptoms like flushing, vomiting, nausea and head-ache which may cause disinterest in the person towards alcohol (Brdley, 1992). Naltrexone has anticraving properties and has been shown to reduce the effects of alcohol. It also reduces the amount of alcohol consumed when used with behavioral therapies (Alcohol abuse, mental health channel). 8. Managing co-existent psychosocial problems: This is important to prevent relapses. 9. Restructuring patients lives: Many alcoholics would have lost money, jobs and family ties. It is important to restructure these to prevent relapse and lead a cherishing life. 10. Continuity of care: This has to done to keep up motivation for abstinence. References Alcohol. Drugfree.org. Retrieved April 30, 2008 http://www.drugfree.org/Portal/drug_guide/Alcohol Alcohol abuse. Mental health Channel. Retrieved April 30, 2008 http://www.mentalhealthchannel.net/alcohol/diagnosis.shtml Barlow, D.H. & Durand, V.M. (2004). Abnormal Psychology: An Integrative Approach. 4th edition. London: Thomson Wadsworth Brdley, K.A. (1992). Management of alcoholism in the primary care setting. West J Med. 156(3), 273–277. Paton, A. (2005). Alcohol in the body. British Medical Journal, 330, 85-87. Tome, S. & Lucey, M.R. (2004). Current Management of Alcoholic Liver Disease. Aliment Pharmacol Ther., 19(7), 707-714. Read More