Alcohol misuse
Definition
Alcohol misuse, abuse or alcoholism are catch-all terms for use of alcohol despite negative consequences. Alcohol dependence is specifically defined as physical dependence on alcohol.
Epidemiology
The prevalence of alcohol dependence is 5% in England and Wales (8% men, 2% women). As of 2001, 27% of men and 15% of women over 16 drunk more than their weekly recommended limit. The same is true for 39% of men's and 22% of women's daily limit.
Pathophysiology
There are a variety of genetic, psychological, social and environmental factors which contribute to alcohol misuse.
The recommended alcohol intake is 3-4 units for men and 2-3 units for women per day. Many people will drink more alcohol than this and it could be argued that this is alcohol misuse. However, the following categories are the important complications of alcohol misuse which need to be identified:
- Alcohol Dependence Syndrome
- Alcohol Withdrawal And Delirium
- Wernicke's Encephalopathy - caused by Thiamine/B1 deficiency
- Korsakoff's Psychosis
Risk Factors
- High-Risk Occupations:
- Publicans
- Doctors
- Journalists
- Shipping And Travel Industries
- Unskilled Worker
- Unemployed
- Lower Social Class
Clinical Features
There are no specific symptoms for alcohol misuse, until it starts to damage the body. It is bad for almost every part of the body, but the main areas it can hurt are:
- Liver - causing fatty liver, alcoholic hepatitis and cirrhosis.
- Pancreas - the biggest cause of pancreatitis.
- Oesophagus - increased likelihood of oesophageal varices and Mallory-Weiss tears.
- Psychiatric - causing depression, suicide and thiamine depletion leading to Wernickes-Korsakoff syndrome.
Investigations
Alcohol history
- How much do you drink?
- What do you drink?
- Who do you drink with?
- Are you worried/has anyone ever commented about your drinking?
- Do you have a problem if you try to stop drinking?
- Do you need an eye opener in the morning?
- If you have one drink, do you have to keep drinking?