Alcoholism: Difference between revisions

Alcoholism
Alcoholism
Other names	Alcohol addiction, alcohol dependence syndrome, alcohol use disorder (AUD)
	A French temperance organisation poster depicting the effects of alcoholism in a family, c. 1915: "Ah! When will we be rid of alcohol?"
Specialty	Psychiatry, clinical psychology, toxicology, addiction medicine
Symptoms	Drinking large amounts of alcohol over a long period, difficulty cutting down, acquiring and drinking alcohol taking up a lot of time, usage resulting in problems, withdrawal occurring when stopping
Complications	Mental illness, delirium, Wernicke–Korsakoff syndrome, irregular heartbeat, cirrhosis of the liver, cancer, fetal alcohol spectrum disorder, suicide
Duration	Long term
Causes	Environmental and genetic factors
Risk factors	Stress, anxiety, easy access
Diagnostic method	Questionnaires, blood tests
Treatment	Alcohol cessation typically with benzodiazepines, counselling, acamprosate, disulfiram, naltrexone Alcoholics Anonymous (AA) and other Twelve Step Programs, AA/Twelve Step Facilitation (AA/TSF)
Frequency	380 million / 5.1% adults (2016)
Deaths	3.3 million / 5.9%

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Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal.^[15] Problematic use of alcohol has been mentioned in the earliest historical records. The World Health Organization (WHO) estimated there were 283 million people with alcohol use disorders worldwide as of 2016^[update].^[12]^[13] The term alcoholism was first coined in 1852,^[16] but alcoholism and alcoholic are sometimes considered stigmatizing and to discourage seeking treatment, so diagnostic terms such as alcohol use disorder or alcohol dependence are often used instead in a clinical context.^[17]^[18]^[19]

Alcohol is addictive, and heavy long-term alcohol use results in many negative health and social consequences. It can damage all the organ systems, but especially affects the brain, heart, liver, pancreas and immune system.^[4]^[5] Heavy alcohol usage can result in trouble sleeping, and severe cognitive issues like dementia, brain damage, or Wernicke–Korsakoff syndrome. Physical effects include irregular heartbeat, an impaired immune response, liver cirrhosis, increased cancer risk, and severe withdrawal symptoms if stopped suddenly.^[4]^[5]^[20] These health effects can reduce life expectancy by 10 years.^[21] Drinking during pregnancy may harm the child's health,^[3] and drunk driving increases the risk of traffic accidents. Alcoholism is also associated with increases in violent and non-violent crime.^[22] While alcoholism directly resulted in 139,000 deaths worldwide in 2013,^[23] in 2012 3.3 million deaths may be attributable globally to alcohol.^[14]

The development of alcoholism is attributed to both environment and genetics equally.^[4] The use of alcohol to self-medicate stress or anxiety can turn into alcoholism.^[24] Someone with a parent or sibling with an alcohol use disorder is three to four times more likely to develop an alcohol use disorder themselves, but only a minority of them do.^[4] Environmental factors include social, cultural and behavioral influences.^[25] High stress levels and anxiety, as well as alcohol's inexpensive cost and easy accessibility, increase the risk.^[4]^[7] People may continue to drink partly to prevent or improve symptoms of withdrawal.^[4] After a person stops drinking alcohol, they may experience a low level of withdrawal lasting for months.^[4] Medically, alcoholism is considered both a physical and mental illness.^[26]^[27] Questionnaires are usually used to detect possible alcoholism.^[4]^[28] Further information is then collected to confirm the diagnosis.^[4]

Treatment of alcoholism may take several forms.^[9] Due to medical problems that can occur during withdrawal, alcohol cessation should be controlled carefully.^[9] One common method involves the use of benzodiazepine medications, such as diazepam.^[9] These can be taken while admitted to a health care institution or individually.^[9] The medications acamprosate or disulfiram may also be used to help prevent further drinking.^[10] Mental illness or other addictions may complicate treatment.^[29] Various individual or group therapy or support groups are used to attempt to keep a person from returning to alcoholism.^[8]^[30] Among them is the abstinence based mutual aid fellowship Alcoholics Anonymous (AA). A 2020 scientific review found that clinical interventions encouraging increased participation in AA (AA/twelve step facilitation (AA/TSF))—resulted in higher abstinence rates over other clinical interventions, and most studies in the review found that AA/TSF led to lower health costs.^[a]^[32]^[33]^[34]

Many terms, some slurs and some informal, have been used to refer to people affected by alcoholism such as tippler, drunkard, dipsomaniac and souse.^[35]

Signs and symptoms

The risk of alcohol dependence begins at low levels of drinking and increases directly with both the volume of alcohol consumed and a pattern of drinking larger amounts on an occasion, to the point of intoxication, which is sometimes called binge drinking. Binge drinking is the most common pattern of alcoholism. It has different definitions and one of this defines it as a pattern of drinking when a male has five or more drinks on an occasion or a female has at least four drinks on an occasion.^[36]

Long-term misuse

Alcoholism is characterized by an increased tolerance to alcohol – which means that an individual can consume more alcohol – and physical dependence on alcohol, which makes it hard for an individual to control their consumption. The physical dependency caused by alcohol can lead to an affected individual having a very strong urge to drink alcohol. These characteristics play a role in decreasing the ability to stop drinking of an individual with an alcohol use disorder.^[37] Alcoholism can have adverse effects on mental health, contributing to psychiatric disorders and increasing the risk of suicide. A depressed mood is a common symptom of heavy alcohol drinkers.^[38]^[39]

Warning signs

Warning signs of alcoholism include the consumption of increasing amounts of alcohol and frequent intoxication, preoccupation with drinking to the exclusion of other activities, promises to quit drinking and failure to keep those promises, the inability to remember what was said or done while drinking (colloquially known as "blackouts"), personality changes associated with drinking, denial or the making of excuses for drinking, the refusal to admit excessive drinking, dysfunction or other problems at work or school, the loss of interest in personal appearance or hygiene, marital and economic problems, and the complaint of poor health, with loss of appetite, respiratory infections, or increased anxiety.^[40]

Physical

Short-term effects

Drinking enough to cause a blood alcohol concentration (BAC) of 0.03–0.12% typically causes an overall improvement in mood and possible euphoria (intense feelings of well-being and happiness), increased self-confidence and sociability, decreased anxiety, a flushed, red appearance in the face and impaired judgment and fine muscle coordination. A BAC of 0.09% to 0.25% causes lethargy, sedation, balance problems and blurred vision. A BAC of 0.18% to 0.30% causes profound confusion, impaired speech (e.g. slurred speech), staggering, dizziness and vomiting. A BAC from 0.25% to 0.40% causes stupor, unconsciousness, anterograde amnesia, vomiting (death may occur due to inhalation of vomit while unconscious) and respiratory depression (potentially life-threatening). A BAC from 0.35% to 0.80% causes a coma (unconsciousness), life-threatening respiratory depression and possibly fatal alcohol poisoning. With all alcoholic beverages, drinking while driving, operating an aircraft or heavy machinery increases the risk of an accident; many countries have penalties for drunk driving.

Long-term effects

Having more than one drink a day for women or two drinks for men increases the risk of heart disease, high blood pressure, atrial fibrillation, and stroke.^[41] Risk is greater with binge drinking, which may also result in violence or accidents. About 3.3 million deaths (5.9% of all deaths) are believed to be due to alcohol each year.^[14] Alcoholism reduces a person's life expectancy by around ten years^[21] and alcohol use is the third leading cause of early death in the United States.^[41] Long-term alcohol misuse can cause a number of physical symptoms, including cirrhosis of the liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, nutritional deficiencies, peptic ulcers^[42] and sexual dysfunction, and can eventually be fatal. Other physical effects include an increased risk of developing cardiovascular disease, malabsorption, alcoholic liver disease, and several cancers such as breast cancer and head and neck cancer.^[43] Damage to the central nervous system and peripheral nervous system can occur from sustained alcohol consumption.^[44]^[45] A wide range of immunologic defects can result and there may be a generalized skeletal fragility, in addition to a recognized tendency to accidental injury, resulting in a propensity for bone fractures.^[46]

Women develop long-term complications of alcohol dependence more rapidly than do men, women also have a higher mortality rate from alcoholism than men.^[47] Examples of long-term complications include brain, heart, and liver damage^[48] and an increased risk of breast cancer. Additionally, heavy drinking over time has been found to have a negative effect on reproductive functioning in women. This results in reproductive dysfunction such as anovulation, decreased ovarian mass, problems or irregularity of the menstrual cycle, and early menopause.^[47] Alcoholic ketoacidosis can occur in individuals who chronically misuse alcohol and have a recent history of binge drinking.^[49]^[50] The amount of alcohol that can be biologically processed and its effects differ between sexes. Equal dosages of alcohol consumed by men and women generally result in women having higher blood alcohol concentrations (BACs), since women generally have a lower weight and higher percentage of body fat and therefore a lower volume of distribution for alcohol than men.^[51]

Psychiatric

Long-term misuse of alcohol can cause a wide range of mental health problems. Severe cognitive problems are common; approximately 10% of all dementia cases are related to alcohol consumption, making it the second leading cause of dementia.^[52] Excessive alcohol use causes damage to brain function, and psychological health can be increasingly affected over time.^[53] Social skills are significantly impaired in people with alcoholism due to the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area of the brain. The social skills that are impaired by alcohol use disorder include impairments in perceiving facial emotions, prosody, perception problems, and theory of mind deficits; the ability to understand humor is also impaired in people who misuse alcohol.^[54] Psychiatric disorders are common in people with alcohol use disorders, with as many as 25% also having severe psychiatric disturbances. The most prevalent psychiatric symptoms are anxiety and depression disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued abstinence.^[55] Psychosis, confusion, and organic brain syndrome may be caused by alcohol misuse, which can lead to a misdiagnosis such as schizophrenia.^[56] Panic disorder can develop or worsen as a direct result of long-term alcohol misuse.^[57]^[58]

The co-occurrence of major depressive disorder and alcoholism is well documented.^[59]^[60]^[61] Among those with comorbid occurrences, a distinction is commonly made between depressive episodes that remit with alcohol abstinence ("substance-induced"), and depressive episodes that are primary and do not remit with abstinence ("independent" episodes).^[62]^[63]^[64] Additional use of other drugs may increase the risk of depression.^[65] Psychiatric disorders differ depending on gender. Women who have alcohol-use disorders often have a co-occurring psychiatric diagnosis such as major depression, anxiety, panic disorder, bulimia, post-traumatic stress disorder (PTSD), or borderline personality disorder. Men with alcohol-use disorders more often have a co-occurring diagnosis of narcissistic or antisocial personality disorder, bipolar disorder, schizophrenia, impulse disorders or attention deficit/hyperactivity disorder (ADHD).^[66] Women with alcohol use disorder are more likely to experience physical or sexual assault, abuse, and domestic violence than women in the general population,^[66] which can lead to higher instances of psychiatric disorders and greater dependence on alcohol.

Social effects

Serious social problems arise from alcohol use disorder; these dilemmas are caused by the pathological changes in the brain and the intoxicating effects of alcohol.^[52]^[67] Alcohol misuse is associated with an increased risk of committing criminal offences, including child abuse, domestic violence, rape, burglary and assault.^[68] Alcoholism is associated with loss of employment,^[69] which can lead to financial problems. Drinking at inappropriate times and behavior caused by reduced judgment can lead to legal consequences, such as criminal charges for drunk driving^[70] or public disorder, or civil penalties for tortious behavior. An alcoholic's behavior and mental impairment while drunk can profoundly affect those surrounding him and lead to isolation from family and friends. This isolation can lead to marital conflict and divorce, or contribute to domestic violence. Alcoholism can also lead to child neglect, with subsequent lasting damage to the emotional development of children of people with alcohol use disorders.^[71] For this reason, children of people with alcohol use disorders can develop a number of emotional problems. For example, they can become afraid of their parents, because of their unstable mood behaviors. They may develop shame over their inadequacy to liberate their parents from alcoholism and, as a result of this, may develop self-image problems, which can lead to depression.^[72]

Alcohol withdrawal

As with similar substances with a sedative-hypnotic mechanism, such as barbiturates and benzodiazepines, withdrawal from alcohol dependence can be fatal if it is not properly managed.^[67]^[73] Alcohol's primary effect is the increase in stimulation of the GABA_A receptor, promoting central nervous system depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in tolerance and physical dependence. When alcohol consumption is stopped too abruptly, the person's nervous system experiences uncontrolled synapse firing. This can result in symptoms that include anxiety, life-threatening seizures, delirium tremens, hallucinations, shakes and possible heart failure.^[74]^[75] Other neurotransmitter systems are also involved, especially dopamine, NMDA and glutamate.^[37]^[76]

Severe acute withdrawal symptoms such as delirium tremens and seizures rarely occur after 1-week post cessation of alcohol. The acute withdrawal phase can be defined as lasting between one and three weeks. In the period of 3–6 weeks following cessation, anxiety, depression, fatigue, and sleep disturbance are common.^[77] Similar post-acute withdrawal symptoms have also been observed in animal models of alcohol dependence and withdrawal.^[78]

A kindling effect also occurs in people with alcohol use disorders whereby each subsequent withdrawal syndrome is more severe than the previous withdrawal episode; this is due to neuroadaptations which occur as a result of periods of abstinence followed by re-exposure to alcohol. Individuals who have had multiple withdrawal episodes are more likely to develop seizures and experience more severe anxiety during withdrawal from alcohol than alcohol-dependent individuals without a history of past alcohol withdrawal episodes. The kindling effect leads to persistent functional changes in brain neural circuits as well as to gene expression.^[79] Kindling also results in the intensification of psychological symptoms of alcohol withdrawal.^[77] There are decision tools and questionnaires that help guide physicians in evaluating alcohol withdrawal. For example, the CIWA-Ar objectifies alcohol withdrawal symptoms in order to guide therapy decisions which allows for an efficient interview while at the same time retaining clinical usefulness, validity, and reliability, ensuring proper care for withdrawal patients, who can be in danger of death.^[80]

Causes

A complex combination of genetic and environmental factors influences the risk of the development of alcoholism.^[81] Genes that influence the metabolism of alcohol also influence the risk of alcoholism, as can a family history of alcoholism.^[82] There is compelling evidence that alcohol use at an early age may influence the expression of genes which increase the risk of alcohol dependence. These genetic and epigenetic results are regarded as consistent with large longitudinal population studies finding that the younger the age of drinking onset, the greater the prevalence of lifetime alcohol dependence.^[83]^[84]

Severe childhood trauma is also associated with a general increase in the risk of drug dependency.^[81] Lack of peer and family support is associated with an increased risk of alcoholism developing.^[81] Genetics and adolescence are associated with an increased sensitivity to the neurotoxic effects of chronic alcohol misuse. Cortical degeneration due to the neurotoxic effects increases impulsive behaviour, which may contribute to the development, persistence and severity of alcohol use disorders. There is evidence that with abstinence, there is a reversal of at least some of the alcohol induced central nervous system damage.^[85] The use of cannabis was associated with later problems with alcohol use.^[86] Alcohol use was associated with an increased probability of later use of tobacco and illegal drugs such as cannabis.^[87]

Availability

Alcohol is the most available, widely consumed, and widely misused recreational drug. Beer alone is the world's most widely consumed^[88] alcoholic beverage; it is the third-most popular drink overall, after water and tea.^[89] It is thought by some to be the oldest fermented beverage.^[90]^[91]^[92]^[93]

Gender difference

Comparison of prevalence of alcohol use disorders by gender and country

World map colored by alcohol use disorders (15+), 12 month prevalence (%), data: WHO (2016)

0.0–3.6 3.7–7.3 7.4–11.0

11.1–14.7 14.8–18.1 19.9–21.2

22.2–23.5 28.8–28.8 33.9–36.9

Based on combined data in the US from SAMHSA's 2004–2005 National Surveys on Drug Use & Health, the rate of past-year alcohol dependence or misuse among persons aged 12 or older varied by level of alcohol use: 44.7% of past month heavy drinkers, 18.5% binge drinkers, 3.8% past month non-binge drinkers, and 1.3% of those who did not drink alcohol in the past month met the criteria for alcohol dependence or misuse in the past year. Males had higher rates than females for all measures of drinking in the past month: any alcohol use (57.5% vs. 45%), binge drinking (30.8% vs. 15.1%), and heavy alcohol use (10.5% vs. 3.3%), and males were twice as likely as females to have met the criteria for alcohol dependence or misuse in the past year (10.5% vs. 5.1%).^[94] However, because females generally weigh less than males, have more fat and less water in their bodies, and metabolize less alcohol in their esophagus and stomach, they are likely to develop higher blood alcohol levels per drink. Women may also be more vulnerable to liver disease.^[95]

Genetic variation

There are genetic variations that affect the risk for alcoholism.^[82]^[81]^[96]^[97] Some of these variations are more common in individuals with ancestry from certain areas; for example, Africa, East Asia, the Middle East and Europe. The variants with strongest effect are in genes that encode the main enzymes of alcohol metabolism, ADH1B and ALDH2.^[82]^[96]^[97] These genetic factors influence the rate at which alcohol and its initial metabolic product, acetaldehyde, are metabolized.^[82] They are found at different frequencies in people from different parts of the world.^[98]^[82]^[99] The alcohol dehydrogenase allele ADH1B*2 causes a more rapid metabolism of alcohol to acetaldehyde, and reduces risk for alcoholism;^[82] it is most common in individuals from East Asia and the Middle East. The alcohol dehydrogenase allele ADH1B*3 also causes a more rapid metabolism of alcohol. The allele ADH1B*3 is only found in some individuals of African descent and certain Native American tribes. African Americans and Native Americans with this allele have a reduced risk of developing alcoholism.^[82]^[99]^[100] Native Americans, however, have a significantly higher rate of alcoholism than average; risk factors such as cultural environmental effects (e.g. trauma) have been proposed to explain the higher rates.^[101]^[102] The aldehyde dehydrogenase allele ALDH2*2 greatly reduces the rate at which acetaldehyde, the initial product of alcohol metabolism, is removed by conversion to acetate; it greatly reduces the risk for alcoholism.^[82]^[98]

A genome-wide association study (GWAS) of more than 100,000 human individuals identified variants of the gene KLB, which encodes the transmembrane protein β-Klotho, as highly associated with alcohol consumption. The protein β-Klotho is an essential element in cell surface receptors for hormones involved in modulation of appetites for simple sugars and alcohol.^[103] Several large GWAS have found differences in the genetics of alcohol consumption and alcohol dependence, although the two are to some degree related.^[96]^[97]^[104]

DNA damage

Alcohol-induced DNA damage, when not properly repaired, may have a key role in the neurotoxicity induced by alcohol.^[105] Metabolic conversion of ethanol to acetaldehyde can occur in the brain and the neurotoxic effects of ethanol appear to be associated with acetaldehyde induced DNA damages including DNA adducts and crosslinks.^[105] In addition to acetaldehyde, alcohol metabolism produces potentially genotoxic reactive oxygen species, which have been demonstrated to cause oxidative DNA damage.^[105]

Diagnosis

Definition

Because there is disagreement on the definition of the word alcoholism, it is not a recognized diagnosis, and the use of the term alcoholism is discouraged due to its heavily stigmatized connotations.^[17]^[18] It is classified as alcohol use disorder^[2] in the DSM-5^[4] or alcohol dependence in the ICD-11.^[106] In 1979, the World Health Organization discouraged the use of alcoholism due to its inexact meaning, preferring alcohol dependence syndrome.^[107]

Misuse, problem use, abuse, and heavy use of alcohol refer to improper use of alcohol, which may cause physical, social, or moral harm to the drinker.^[108] The Dietary Guidelines for Americans, issued by the United States Department of Agriculture (USDA) in 2005, defines "moderate use" as no more than two alcoholic beverages a day for men and no more than one alcoholic beverage a day for women.^[109] The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as the amount of alcohol leading to a blood alcohol content (BAC) of 0.08, which, for most adults, would be reached by consuming five drinks for men or four for women over a two-hour period. According to the NIAAA, men may be at risk for alcohol-related problems if their alcohol consumption exceeds 14 standard drinks per week or 4 drinks per day, and women may be at risk if they have more than 7 standard drinks per week or 3 drinks per day. It defines a standard drink as one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits.^[110] Despite this risk, a 2014 report in the National Survey on Drug Use and Health found that only 10% of either "heavy drinkers" or "binge drinkers" defined according to the above criteria also met the criteria for alcohol dependence, while only 1.3% of non-binge drinkers met the criteria. An inference drawn from this study is that evidence-based policy strategies and clinical preventive services may effectively reduce binge drinking without requiring addiction treatment in most cases.^[111]

Alcoholism

The term alcoholism is commonly used amongst laypeople, but the word is poorly defined. Despite the imprecision inherent in the term, there have been attempts to define how the word alcoholism should be interpreted when encountered. In 1992, it was defined by the National Council on Alcoholism and Drug Dependence (NCADD) and ASAM 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."^[112] MeSH has had an entry for alcoholism since 1999, and references the 1992 definition.^[113]

The WHO calls alcoholism "a term of long-standing use and variable meaning", and use of the term was disfavored by a 1979 WHO expert committee.

In professional and research contexts, the term alcoholism is not currently favored, but rather alcohol abuse, alcohol dependence, or alcohol use disorder are used.^[4]^[2] Talbot (1989) observes that alcoholism in the classical disease model follows a progressive course: if people continue to drink, their condition will worsen. This will lead to harmful consequences in their lives, physically, mentally, emotionally, and socially.^[114] Johnson (1980) proposed that the emotional progression of the addicted people's response to alcohol has four phases. The first two are considered "normal" drinking and the last two are viewed as "typical" alcoholic drinking.^[114] Johnson's four phases consist of:

Learning the mood swing. People are introduced to alcohol (in some cultures this can happen at a relatively young age), and they enjoy the happy feeling it produces. At this stage, there is no emotional cost.
Seeking the mood swing. People will drink to regain that happy feeling in phase 1; the drinking will increase as more alcohol is required to achieve the same effect. Again at this stage, there are no significant consequences.
At the third stage there are physical and social consequences such as hangovers, family problems, and work problems. People will continue to drink excessively, disregarding the problems.
The fourth stage can be detrimental with a risk for premature death. People in this phase now drink to feel normal and block out the feelings of overwhelming guilt, remorse, anxiety, and shame they experience when sober.^[114]

DSM and ICD

In the United States, the Diagnostic and Statistical Manual of Mental Disorders (DSM) is the most common diagnostic guide for substance use disorders, whereas most countries use the International Classification of Diseases (ICD) for diagnostic (and other) purposes. The two manuals use similar but not identical nomenclature to classify alcohol problems.

Manual	Nomenclature	Definition
DSM-IV	Alcohol abuse, or Alcohol dependence	Alcohol abuse – repeated use despite recurrent adverse consequences.^[115] Alcohol dependence – alcohol abuse combined with tolerance, withdrawal, and an uncontrollable drive to drink.^[115] The term "alcoholism" was split into "alcohol abuse" and "alcohol dependence" in 1980's DSM-III, and in 1987's DSM-III-R behavioral symptoms were moved from "abuse" to "dependence".^[116] Some scholars suggested that DSM-5 merges alcohol abuse and alcohol dependence into a single new entry,^[117] named "alcohol-use disorder".^[118]
DSM-5	Alcohol use disorder	"A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by [two or more symptoms out of a total of 12], occurring within a 12-month period ...."^[119]
ICD-10	Alcohol harmful use, or Alcohol dependence syndrome	Definitions are similar to that of the DSM-IV. The World Health Organization uses the term "alcohol dependence syndrome" rather than alcoholism.^[107] The concept of "harmful use" (as opposed to "abuse") was introduced in 1992's ICD-10 to minimize underreporting of damage in the absence of dependence.^[116] The term "alcoholism" was removed from ICD between ICD-8/ICDA-8 and ICD-9.^[120]
ICD-11	Episode of harmful use of alcohol, Harmful pattern of use of alcohol, or Alcohol dependence	Episode of harmful use of alcohol – "A single episode of use of alcohol that has caused damage to a person's physical or mental health or has resulted in behaviour leading to harm to the health of others ..."^[121] Harmful pattern of use of alcohol – "A pattern of alcohol use that has caused damage to a person's physical or mental health or has resulted in behaviour leading to harm to the health of others ..."^[122] Alcohol dependence – "Alcohol dependence is a disorder of regulation of alcohol use arising from repeated or continuous use of alcohol. The characteristic feature is a strong internal drive to use alcohol. ... The features of dependence are usually evident over a period of at least 12 months but the diagnosis may be made if alcohol use is continuous (daily or almost daily) for at least 1 month."^[123]

Social barriers

Attitudes and social stereotypes can create barriers to the detection and treatment of alcohol use disorder. This is more of a barrier for women than men.^[why?] Fear of stigmatization may lead women to deny that they have a medical condition, to hide their drinking, and to drink alone. This pattern, in turn, leads family, physicians, and others to be less likely to suspect that a woman they know has alcohol use disorder.^[47] In contrast, reduced fear of stigma may lead men to admit that they are having a medical condition, to display their drinking publicly, and to drink in groups. This pattern, in turn, leads family, physicians, and others to be more likely to suspect that a man they know is someone with an alcohol use disorder.^[66]

Screening

Screening is recommended among those over the age of 18.^[124] Several tools may be used to detect a loss of control of alcohol use. These tools are mostly self-reports in questionnaire form. Another common theme is a score or tally that sums up the general severity of alcohol use.^[125]

The CAGE questionnaire, named for its four questions, is one such example that may be used to screen patients quickly in a doctor's office.

Two "yes" responses indicate that the respondent should be investigated further.
The questionnaire asks the following questions:

Have you ever felt you needed to cut down on your drinking?

Have people annoyed you by criticizing your drinking?

Have you ever felt guilty about drinking?

Have you ever felt you needed a drink first thing in the morning (eye-opener) to steady your nerves or to get rid of a hangover?^[126]^[127]

The CAGE questionnaire has demonstrated a high effectiveness in detecting alcohol-related problems; however, it has limitations in people with less severe alcohol-related problems, white women and college students.^[128]

Other tests are sometimes used for the detection of alcohol dependence, such as the Alcohol Dependence Data Questionnaire, which is a more sensitive diagnostic test than the CAGE questionnaire. It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol use.^[129] The Michigan Alcohol Screening Test (MAST) is a screening tool for alcoholism widely used by courts to determine the appropriate sentencing for people convicted of alcohol-related offenses,^[130] driving under the influence being the most common. The Alcohol Use Disorders Identification Test (AUDIT), a screening questionnaire developed by the World Health Organization, is unique in that it has been validated in six countries and is used internationally. Like the CAGE questionnaire, it uses a simple set of questions – a high score earning a deeper investigation.^[131] The Paddington Alcohol Test (PAT) was designed to screen for alcohol-related problems amongst those attending Accident and Emergency departments. It concords well with the AUDIT questionnaire but is administered in a fifth of the time.^[132]

Urine and blood tests

There are reliable tests for the actual use of alcohol, one common test being that of blood alcohol content (BAC).^[133] These tests do not differentiate people with alcohol use disorders from people without; however, long-term heavy drinking does have a few recognizable effects on the body, including:^{[citation needed]}

Macrocytosis (enlarged MCV)
Elevated GGT
Moderate elevation of AST and ALT and an AST: ALT ratio of 2:1
High carbohydrate deficient transferrin (CDT)

With regard to alcoholism, BAC is useful to judge alcohol tolerance, which in turn is a sign of alcoholism.^[4] Electrolyte and acid-base abnormalities including hypokalemia, hypomagnesemia, hyponatremia, hyperuricemia, metabolic acidosis, and respiratory alkalosis are common in people with alcohol use disorders.^[5]

However, none of these blood tests for biological markers is as sensitive as screening questionnaires.

Prevention

The World Health Organization, the European Union and other regional bodies, national governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism.^[134]^[135]

Increasing the age at which alcohol can be purchased, and banning or restricting alcohol beverage advertising are common methods to reduce alcohol use among adolescents and young adults in particular. Another common method of alcoholism prevention is taxation of alcohol products – increasing price of alcohol by 10% is linked with reduction of consumption of up to 10%.^[136]

Credible, evidence-based educational campaigns in the mass media about the consequences of alcohol misuse have been recommended. Guidelines for parents to prevent alcohol misuse amongst adolescents, and for helping young people with mental health problems have also been suggested.^[137]

Because alcohol is often used for self-medication of conditions like anxiety temporarily, prevention of alcoholism may be attempted by reducing the severity or prevalence of stress and anxiety in individuals.^[4]^[7]

Management

Treatments are varied because there are multiple perspectives of alcoholism. Those who approach alcoholism as a medical condition or disease recommend differing treatments from, for instance, those who approach the condition as one of social choice. Most treatments focus on helping people discontinue their alcohol intake, followed up with life training and/or social support to help them resist a return to alcohol use. Since alcoholism involves multiple factors which encourage a person to continue drinking, they must all be addressed to successfully prevent a relapse. An example of this kind of treatment is detoxification followed by a combination of supportive therapy, attendance at self-help groups, and ongoing development of coping mechanisms. Much of the treatment community for alcoholism supports an abstinence-based zero tolerance approach popularized by the 12 step program of Alcoholics Anonymous; however, some prefer a harm-reduction approach.^[138]

Cessation of alcohol intake

Medical treatment for alcohol detoxification usually involves administration of a benzodiazepine, in order to ameliorate alcohol withdrawal syndrome's adverse impact.^[139]^[140] The addition of phenobarbital improves outcomes if benzodiazepine administration lacks the usual efficacy, and phenobarbital alone might be an effective treatment.^[141] Propofol also might enhance treatment for individuals showing limited therapeutic response to a benzodiazepine.^[142]^[143] Individuals who are only at risk of mild to moderate withdrawal symptoms can be treated as outpatients. Individuals at risk of a severe withdrawal syndrome as well as those who have significant or acute comorbid conditions can be treated as inpatients. Direct treatment can be followed by a treatment program for alcohol dependence or alcohol use disorder to attempt to reduce the risk of relapse.^[9] Experiences following alcohol withdrawal, such as depressed mood and anxiety, can take weeks or months to abate while other symptoms persist longer due to persisting neuroadaptations.^[77]

Psychological

Various forms of group therapy or psychotherapy are sometimes used to encourage and support abstinence from alcohol, or to reduce alcohol consumption to levels that are not associated with adverse outcomes. Mutual-aid group-counseling is an approach used to facilitate relapse prevention.^[8] Alcoholics Anonymous was one of the earliest organizations formed to provide mutual peer support and non-professional counseling, however the effectiveness of Alcoholics Anonymous is disputed.^[144] A 2020 Cochrane review concluded that Twelve-Step Facilitation (TSF) probably achieves outcomes such as fewer drinks per drinking day, however evidence for such a conclusion comes from low to moderate certainty evidence "so should be regarded with caution".^[145] Others include LifeRing Secular Recovery, SMART Recovery, Women for Sobriety, and Secular Organizations for Sobriety.^[146]

Manualized^[147] Twelve Step Facilitation (TSF) interventions (i.e. therapy which encourages active, long-term Alcoholics Anonymous participation) for Alcohol Use Disorder lead to higher abstinence rates, compared to other clinical interventions and to wait-list control groups.^[148]

Moderate drinking

Moderate drinking amongst people with alcohol dependence—often termed 'controlled drinking'—has been subject to significant controversy.^[149] Indeed, much of the skepticism toward the viability of moderate drinking goals stems from historical ideas about 'alcoholism', now replaced with 'alcohol use disorder' or alcohol dependence in most scientific contexts. A 2021 meta-analysis and systematic review of controlled drinking covering 22 studies concluded controlled drinking was a 'non-inferior' outcome to abstinence for many drinkers.^[150]

Rationing and moderation programs such as Moderation Management and DrinkWise do not mandate complete abstinence. While most people with alcohol use disorders are unable to limit their drinking in this way, some return to moderate drinking. A 2002 US study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed that 17.7% of individuals diagnosed as alcohol dependent more than one year prior returned to low-risk drinking. This group, however, showed fewer initial symptoms of dependency.^[151]

A follow-up study, using the same subjects that were judged to be in remission in 2001–2002, examined the rates of return to problem drinking in 2004–2005. The study found abstinence from alcohol was the most stable form of remission for recovering alcoholics.^[152] There was also a 1973 study showing chronic alcoholics drinking moderately again,^[153] but a 1982 follow-up showed that 95% of subjects were not able to maintain drinking in moderation over the long term.^[154]^[155] Another study was a long-term (60 year) follow-up of two groups of alcoholic men which concluded that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence."^[156] Internet based measures appear to be useful at least in the short term.^[157]

Medications

In the United States there are four approved medications for alcoholism: acamprosate, two methods of using naltrexone and disulfiram.^[158]

Acamprosate may stabilise the brain chemistry that is altered due to alcohol dependence via antagonising the actions of glutamate, a neurotransmitter which is hyperactive in the post-withdrawal phase.^[159] By reducing excessive NMDA activity which occurs at the onset of alcohol withdrawal, acamprosate can reduce or prevent alcohol withdrawal related neurotoxicity.^[160] Acamprosate reduces the risk of relapse amongst alcohol-dependent persons.^[161]^[162]
Naltrexone is a competitive antagonist for opioid receptors, effectively blocking the effects of endorphins and opioids. Naltrexone is used to decrease cravings for alcohol and encourage abstinence. Alcohol causes the body to release endorphins, which in turn release dopamine and activate the reward pathways; hence in the body Naltrexone reduces the pleasurable effects from consuming alcohol.^[163] Evidence supports a reduced risk of relapse among alcohol-dependent persons and a decrease in excessive drinking.^[162] Nalmefene also appears effective and works in a similar manner.^[162]
Disulfiram prevents the elimination of acetaldehyde, a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many hangover symptoms from alcohol use. The overall effect is discomfort when alcohol is ingested: an extremely rapid and long-lasting, uncomfortable hangover.

Several other drugs are also used and many are under investigation.

Benzodiazepines, while useful in the management of acute alcohol withdrawal, if used long-term can cause a worse outcome in alcoholism. Alcoholics on chronic benzodiazepines have a lower rate of achieving abstinence from alcohol than those not taking benzodiazepines. This class of drugs is commonly prescribed to alcoholics for insomnia or anxiety management.^[164] Initiating prescriptions of benzodiazepines or sedative-hypnotics in individuals in recovery has a high rate of relapse with one author reporting more than a quarter of people relapsed after being prescribed sedative-hypnotics. Those who are long-term users of benzodiazepines should not be withdrawn rapidly, as severe anxiety and panic may develop, which are known risk factors for alcohol use disorder relapse. Taper regimes of 6–12 months have been found to be the most successful, with reduced intensity of withdrawal.^[165]^[166]
Calcium carbimide works in the same way as disulfiram; it has an advantage in that the occasional adverse effects of disulfiram, hepatotoxicity and drowsiness, do not occur with calcium carbimide.^[167]
Ondansetron and topiramate are supported by tentative evidence in people with certain genetic patterns.^[168]^[169] Evidence for ondansetron is stronger in people who have recently started to abuse alcohol.^[168] Topiramate is a derivative of the naturally occurring sugar monosaccharide D-fructose. Review articles characterize topiramate as showing "encouraging",^[168] "promising",^[168] "efficacious",^[170] and "insufficient"^[171] results in the treatment of alcohol use disorders.

Evidence does not support the use of selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), antipsychotics, or gabapentin.^[162]

Research

Topiramate, a derivative of the naturally occurring sugar monosaccharide D-fructose, has been found effective in helping alcoholics quit or cut back on the amount they drink. Evidence suggests that topiramate antagonizes excitatory glutamate receptors, inhibits dopamine release, and enhances inhibitory gamma-aminobutyric acid function. A 2008 review of the effectiveness of topiramate concluded that the results of published trials are promising, however as of 2008, data was insufficient to support using topiramate in conjunction with brief weekly compliance counseling as a first-line agent for alcohol dependence.^[172] A 2010 review found that topiramate may be superior to existing alcohol pharmacotherapeutic options. Topiramate effectively reduces craving and alcohol withdrawal severity as well as improving quality-of-life-ratings.^[173]

Baclofen, a GABA_B receptor agonist, is under study for the treatment of alcoholism.^[174] According to a 2017 Cochrane Systematic Review, there is insufficient evidence to determine the effectiveness or safety for the use of baclofen for withdrawal symptoms in alcoholism.^[175] Psilocybin-assisted psychotherapy is under study for the treatment of patients with alcohol use disorder.^[176]^[177]

Dual addictions and dependencies

Alcoholics may also require treatment for other psychotropic drug addictions and drug dependencies. The most common dual dependence syndrome with alcohol dependence is benzodiazepine dependence, with studies showing 10–20% of alcohol-dependent individuals had problems of dependence and/or misuse problems of benzodiazepine drugs such as diazepam or clonazepam. These drugs are, like alcohol, depressants. Benzodiazepines may be used legally, if they are prescribed by doctors for anxiety problems or other mood disorders, or they may be purchased as illegal drugs. Benzodiazepine use increases cravings for alcohol and the volume of alcohol consumed by problem drinkers.^[178] Benzodiazepine dependency requires careful reduction in dosage to avoid benzodiazepine withdrawal syndrome and other health consequences. Dependence on other sedative-hypnotics such as zolpidem and zopiclone as well as opiates and illegal drugs is common in alcoholics. Alcohol itself is a sedative-hypnotic and is cross-tolerant with other sedative-hypnotics such as barbiturates, benzodiazepines and nonbenzodiazepines. Dependence upon and withdrawal from sedative-hypnotics can be medically severe and, as with alcohol withdrawal, there is a risk of psychosis or seizures if not properly managed.^[179]

Epidemiology

The World Health Organization estimates that as of 2016^[update] there are about 380 million people with alcoholism worldwide (5.1% of the population over 15 years of age),^[12]^[13] with it being most common among males and young adults.^[4] Geographically, it is least common in Africa (1.1% of the population) and has the highest rates in Eastern Europe (11%).^[4]

As of 2015^[update] in the United States, about 17 million (7%) of adults and 0.7 million (2.8%) of those age 12 to 17 years of age are affected.^[14] About 12% of American adults have had an alcohol dependence problem at some time in their life.^[181]

In the United States and Western Europe, 10–20% of men and 5–10% of women at some point in their lives will meet criteria for alcoholism.^[182] In England, the number of "dependent drinkers" was calculated as over 600,000 in 2019.^[183] Estonia had the highest death rate from alcohol in Europe in 2015 at 8.8 per 100,000 population.^[184] In the United States, 30% of people admitted to hospital have a problem related to alcohol.^[185]

Within the medical and scientific communities, there is a broad consensus regarding alcoholism as a disease state. For example, the American Medical Association considers alcohol a drug and states that "drug addiction is a chronic, relapsing brain disease characterized by compulsive drug seeking and use despite often devastating consequences. It results from a complex interplay of biological vulnerability, environmental exposure, and developmental factors (e.g., stage of brain maturity)."^[186] Alcoholism has a higher prevalence among men, though, in recent decades, the proportion of female alcoholics has increased.^[48] Current evidence indicates that in both men and women, alcoholism is 50–60% genetically determined, leaving 40–50% for environmental influences.^[187] Most alcoholics develop alcoholism during adolescence or young adulthood.^[81]

Prognosis

Alcoholism often reduces a person's life expectancy by around ten years.^[21] The most common cause of death in alcoholics is from cardiovascular complications.^[188] There is a high rate of suicide in chronic alcoholics, which increases the longer a person drinks. Approximately 3–15% of alcoholics die by suicide,^[189] and research has found that over 50% of all suicides are associated with alcohol or drug dependence. This is believed to be due to alcohol causing physiological distortion of brain chemistry, as well as social isolation. Suicide is also common in adolescent alcohol abusers. Research in 2000 found that 25% of suicides in adolescents were related to alcohol abuse.^[190]

Among those with alcohol dependence after one year, some met the criteria for low-risk drinking, even though only 26% of the group received any treatment, with the breakdown as follows: 25% were found to be still dependent, 27% were in partial remission (some symptoms persist), 12% asymptomatic drinkers (consumption increases chances of relapse) and 36% were fully recovered – made up of 18% low-risk drinkers plus 18% abstainers.^[191] In contrast, however, the results of a long-term (60-year) follow-up of two groups of alcoholic men indicated that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence....return-to-controlled drinking, as reported in short-term studies, is often a mirage."^[156]

History

Historically the name dipsomania was coined by German physician C. W. Hufeland in 1819 before it was superseded by alcoholism.^[192]^[193] That term now has a more specific meaning.^[194] The term alcoholism was first used by Swedish physician Magnus Huss in an 1852 publication to describe the systemic adverse effects of alcohol.^[16]

Alcohol has a long history of use and misuse throughout recorded history. Biblical, Egyptian and Babylonian sources record the history of abuse and dependence on alcohol. In some ancient cultures alcohol was worshiped and in others, its misuse was condemned. Excessive alcohol misuse and drunkenness were recognized as causing social problems even thousands of years ago. However, the defining of habitual drunkenness as it was then known as and its adverse consequences were not well established medically until the 18th century. In 1647 a Greek monk named Agapios was the first to document that chronic alcohol misuse was associated with toxicity to the nervous system and body which resulted in a range of medical disorders such as seizures, paralysis, and internal bleeding. In the 1910s and 1920s, the effects of alcohol misuse and chronic drunkenness boosted membership of the temperance movement and led to the prohibition of alcohol in many countries in North America and the Nordic countries, nationwide bans on the production, importation, transportation, and sale of alcoholic beverages that generally remained in place until the late 1920s or early 1930s; these policies resulted in the decline of death rates from cirrhosis and alcoholism.^[195] In 2005, alcohol dependence and misuse was estimated to cost the US economy approximately 220 billion dollars per year, more than cancer and obesity.^[196]

Society and culture

The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to society; for example, money due to lost labor-hours, medical costs due to injuries due to drunkenness and organ damage from long-term use, and secondary treatment costs, such as the costs of rehabilitation facilities and detoxification centers. Alcohol use is a major contributing factor for head injuries, motor vehicle injuries (27%), interpersonal violence (18%), suicides (18%), and epilepsy (13%).^[197] Beyond the financial costs that alcohol consumption imposes, there are also significant social costs to both the alcoholic and their family and friends.^[67] For instance, alcohol consumption by a pregnant woman can lead to an incurable and damaging condition known as fetal alcohol syndrome, which often results in cognitive deficits, mental health problems, an inability to live independently and an increased risk of criminal behaviour, all of which can cause emotional stress for parents and caregivers.^[198]^[199] Estimates of the economic costs of alcohol misuse, collected by the World Health Organization, vary from 1–6% of a country's GDP.^[200] One Australian estimate pegged alcohol's social costs at 24% of all drug misuse costs; a similar Canadian study concluded alcohol's share was 41%.^[201] One study quantified the cost to the UK of all forms of alcohol misuse in 2001 as £18.5–20 billion.^[183]^[202] All economic costs in the United States in 2006 have been estimated at $223.5 billion.^[203]

The idea of hitting rock bottom refers to an experience of stress that can be attributed to alcohol misuse.^[204] There is no single definition for this idea, and people may identify their own lowest points in terms of lost jobs, lost relationships, health problems, legal problems, or other consequences of alcohol misuse.^[205] The concept is promoted by 12-step recovery groups and researchers using the transtheoretical model of motivation for behavior change.^[205] The first use of this slang phrase in the formal medical literature appeared in a 1965 review in the British Medical Journal,^[205] which said that some men refused treatment until they "hit rock bottom", but that treatment was generally more successful for "the alcohol addict who has friends and family to support him" than for impoverished and homeless addicts.^[206]

Stereotypes of alcoholics are often found in fiction and popular culture. The "town drunk" is a stock character in Western popular culture. Stereotypes of drunkenness may be based on racism or xenophobia, as in the fictional depiction of the Irish as heavy drinkers.^[207] Studies by social psychologists Stivers and Greeley attempt to document the perceived prevalence of high alcohol consumption amongst the Irish in America.^[208] Alcohol consumption is relatively similar between many European cultures, the United States, and Australia. In Asian countries that have a high gross domestic product, there is heightened drinking compared to other Asian countries, but it is nowhere near as high as it is in other countries like the United States. It is also inversely seen, with countries that have very low gross domestic product showing high alcohol consumption.^[209] In a study done on Korean immigrants in Canada, they reported alcohol was typically an integral part of their meal but is the only time solo drinking should occur. They also generally believe alcohol is necessary at any social event, as it helps conversations start.^[210]

Peyote, a psychoactive agent, has even shown promise in treating alcoholism. Alcohol had actually replaced peyote as Native Americans' psychoactive agent of choice in rituals when peyote was outlawed.^[211]

Notes

^ "Twelve-Step Facilitation (TSF) interventions include extended counseling, adopting some of the techniques and principles of AA, as well as brief interventions designed to link individuals to community AA groups."^[31]

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@@ Line 9: / Line 9: @@
 {{Infobox medical condition (new)
 | name          = Alcoholism
-| synonyms      = Alcohol addiction, alcohol dependence syndrome, alcohol use disorder (AUD)<ref name=MESH2020>{{cite web |title=Alcoholism MeSH Descriptor Data 2020 |url=https://meshb.nlm.nih.gov/record/ui?ui=D000437 |website=meshb.nlm.nih.gov |access-date=9 May 2020}}</ref>
+| synonyms      = Alcohol addiction, alcohol dependence syndrome, alcohol use disorder (AUD)<ref name=MESH2020>{{cite web |title=Alcoholism MeSH Descriptor Data 2020 |url=https://meshb.nlm.nih.gov/record/ui?ui=D000437 |website=meshb.nlm.nih.gov |access-date=9 May 2020 |archive-date=23 June 2020 |archive-url=https://web.archive.org/web/20200623014248/https://meshb.nlm.nih.gov/record/ui?ui=D000437 |url-status=live }}</ref>
 | image         = A wife asking her drunkard husband to hand over a bottle Wellcome L0067935.jpg
 | caption       = A French temperance organisation poster depicting the [[alcoholism in family systems|effects of alcoholism in a family]], {{circa|1915}}: "Ah! When will we be rid of alcohol?"
@@ Line 25: / Line 25: @@
 | medication    =
 | prognosis     =
-| frequency     = 380 million / 5.1% adults (2016)<ref name=WHO2018>{{cite book|title=Global status report on alcohol and health 2018|date=2018|publisher=World Health Organization|isbn= 978-92-4-156563-9|pages=72, 80|url=https://apps.who.int/iris/bitstream/handle/10665/274603/9789241565639-eng.pdf?ua=1}}</ref><ref name=un2020/>
+| frequency     = 380 million / 5.1% adults (2016)<ref name=WHO2018>{{cite book|title=Global status report on alcohol and health 2018|date=2018|publisher=World Health Organization|isbn=978-92-4-156563-9|pages=72, 80|url=https://apps.who.int/iris/bitstream/handle/10665/274603/9789241565639-eng.pdf?ua=1|access-date=1 July 2024|archive-date=25 July 2019|archive-url=https://web.archive.org/web/20190725205222/https://apps.who.int/iris/bitstream/handle/10665/274603/9789241565639-eng.pdf?ua=1|url-status=live}}</ref><ref name=un2020/>
 | deaths        = 3.3 million / 5.9%<ref name=NIH2015Stats/>
 | alt           =
 }}
-'''Alcoholism''' is the continued drinking of [[alcohol (drug)|alcohol]] despite it causing problems.  Some definitions require evidence of dependence and withdrawal.<ref>{{cite book | vauthors = Littrell J |title=Understanding and Treating Alcoholism Volume I: An Empirically Based Clinician's Handbook for the Treatment of Alcoholism: Volume II: Biological, Psychological, and Social Aspects of Alcohol Consumption and Abuse|date=2014|publisher=Taylor and Francis|location=Hoboken|isbn=978-1-317-78314-5|page=55|url=https://books.google.com/books?id=2k57AgAAQBAJ&pg=PA55|quote=The World Health Organization defines alcoholism as any drinking which results in problems|url-status=live|archive-url=https://web.archive.org/web/20170720112756/https://books.google.com/books?id=2k57AgAAQBAJ&pg=PA55|archive-date=20 July 2017}}</ref> Problematic use of alcohol has been mentioned in the earliest historical records. The [[World Health Organization]] (WHO) estimated there were 283 million people with alcohol use disorders worldwide {{as of|2016|lc=y}}.<ref name=WHO2018/><ref name=un2020>{{cite web|url=https://population.un.org/wpp/DataQuery/|title=World Population Prospects – Population Division|publisher=United Nations}}</ref> The term ''alcoholism'' was first coined in 1852,<ref name="huss1852">{{cite book|title=Alcoholismus chronicus, eller Chronisk alkoholssjukdom|url={{google books |plainurl=y |id=wt6r2Zw8sCEC|page=5}}|publisher=Stockholm und Leipzig|access-date=19 February 2008|year=1852}}</ref> but ''alcoholism'' and ''alcoholic'' are [[Social stigma|stigmatizing]] and discourage seeking treatment, so clinical diagnostic terms such as '''alcohol use disorder''' or '''[[alcohol dependence]]''' are used instead.<ref name=morrismoss2022>{{cite journal |last1=Morris |first1=J. |last2=Moss |first2=A. C. |last3=Albery |first3=I. P. |last4=Heather |first4=N. |date=1 January 2022 |title=The 'alcoholic other': Harmful drinkers resist problem recognition to manage identity threat |url=https://www.sciencedirect.com/science/article/abs/pii/S0306460321002781 |journal=Addictive Behaviors |volume=124 |pages=107093 |doi=10.1016/j.addbeh.2021.107093|pmid=34500234 }}</ref><ref name=ashfordbrown2018>{{cite journal |last1=Ashford |first1=Robert D. |last2=Brown |first2=Austin M. |last3=Curtis |first3=Brenda |date=1 August 2018 |title=Substance use, recovery, and linguistics: The impact of word choice on explicit and implicit bias |journal=Drug and Alcohol Dependence |volume=189 |pages=131–138 |doi=10.1016/j.drugalcdep.2018.05.005|pmid=29913324 |pmc=6330014 }}</ref>
+'''Alcoholism''' is the continued drinking of [[alcohol (drug)|alcohol]] despite it causing problems.  Some definitions require evidence of dependence and withdrawal.<ref>{{cite book | vauthors = Littrell J |title=Understanding and Treating Alcoholism Volume I: An Empirically Based Clinician's Handbook for the Treatment of Alcoholism: Volume II: Biological, Psychological, and Social Aspects of Alcohol Consumption and Abuse|date=2014|publisher=Taylor and Francis|location=Hoboken|isbn=978-1-317-78314-5|page=55|url=https://books.google.com/books?id=2k57AgAAQBAJ&pg=PA55|quote=The World Health Organization defines alcoholism as any drinking which results in problems|url-status=live|archive-url=https://web.archive.org/web/20170720112756/https://books.google.com/books?id=2k57AgAAQBAJ&pg=PA55|archive-date=20 July 2017}}</ref> Problematic use of alcohol has been mentioned in the earliest historical records. The [[World Health Organization]] (WHO) estimated there were 283 million people with alcohol use disorders worldwide {{as of|2016|lc=y}}.<ref name=WHO2018/><ref name=un2020>{{cite web|url=https://population.un.org/wpp/DataQuery/|title=World Population Prospects – Population Division|publisher=United Nations|access-date=1 July 2024|archive-date=15 June 2020|archive-url=https://web.archive.org/web/20200615001511/https://population.un.org/wpp/DataQuery/|url-status=live}}</ref> The term ''alcoholism'' was first coined in 1852,<ref name="huss1852">{{cite book|title=Alcoholismus chronicus, eller Chronisk alkoholssjukdom|url={{google books |plainurl=y |id=wt6r2Zw8sCEC|page=5}}|publisher=Stockholm und Leipzig|access-date=19 February 2008|year=1852}}</ref> but ''alcoholism'' and ''alcoholic'' are sometimes considered [[Social stigma|stigmatizing]] and to discourage seeking treatment, so diagnostic terms such as '''alcohol use disorder''' or '''[[alcohol dependence]]''' are often used instead in a clinical context.<ref name=morrismoss2022>{{cite journal |last1=Morris |first1=J. |last2=Moss |first2=A. C. |last3=Albery |first3=I. P. |last4=Heather |first4=N. |date=1 January 2022 |title=The 'alcoholic other': Harmful drinkers resist problem recognition to manage identity threat |url=https://www.sciencedirect.com/science/article/abs/pii/S0306460321002781 |journal=Addictive Behaviors |volume=124 |pages=107093 |doi=10.1016/j.addbeh.2021.107093 |pmid=34500234 |access-date=1 July 2024 |archive-date=30 March 2024 |archive-url=https://web.archive.org/web/20240330234059/https://www.sciencedirect.com/science/article/abs/pii/S0306460321002781 |url-status=live }}</ref><ref name=ashfordbrown2018>{{cite journal |last1=Ashford |first1=Robert D. |last2=Brown |first2=Austin M. |last3=Curtis |first3=Brenda |date=1 August 2018 |title=Substance use, recovery, and linguistics: The impact of word choice on explicit and implicit bias |journal=Drug and Alcohol Dependence |volume=189 |pages=131–138 |doi=10.1016/j.drugalcdep.2018.05.005|pmid=29913324 |pmc=6330014 }}</ref><ref>{{cite journal |last1=Rehm |first1=J |title=The risks associated with alcohol use and alcoholism |journal=[[Alcohol Research & Health]] |date=2011 |volume=34 |issue=2 |pages=135–143 |pmid=22330211 |pmc=3307043 |url=https://pmc.ncbi.nlm.nih.gov/articles/PMC3307043/}}</ref>
 <!-- Summary of negative impacts-->
-Alcohol is [[Addiction|addictive]], and heavy long-term alcohol use results in many negative health and social consequences. It can damage all the organ systems, but especially affects the brain, heart, liver, [[pancreas]] and [[immune system]].<ref name=DSM5 /><ref name=NIHHx /> Heavy alcohol usage can result in [[Alcohol use and sleep|trouble sleeping]], and severe cognitive issues like [[alcohol-related dementia|dementia]], [[Alcohol-related brain damage|brain damage]], or [[Wernicke–Korsakoff syndrome]]. Physical effects include [[Heart arrhythmia|irregular heartbeat]], an impaired immune response, liver [[cirrhosis]], [[alcohol and cancer|increased cancer risk]], and [[delirium tremens|severe withdrawal symptoms]] if stopped suddenly.<ref name=DSM5 /><ref name=NIHHx>{{cite web|title=Alcohol's Effects on the Body|url=http://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body|access-date=9 May 2015|url-status=live|archive-url=https://web.archive.org/web/20150603230352/http://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body|archive-date=3 June 2015|date=14 September 2011}}</ref><ref>{{cite journal | vauthors = Romeo J, Wärnberg J, Nova E, Díaz LE, Gómez-Martinez S, Marcos A | title = Moderate alcohol consumption and the immune system: a review | journal = The British Journal of Nutrition | volume = 98 | pages = S111-5 | date = October 2007 | issue = Suppl 1 | pmid = 17922947 | doi = 10.1017/S0007114507838049 | doi-access = free }}</ref> These health effects can reduce [[life expectancy]] by 10 years.<ref name=Schu2014>{{cite journal | vauthors = Schuckit MA | title = Recognition and management of withdrawal delirium (delirium tremens) | journal = The New England Journal of Medicine | volume = 371 | issue = 22 | pages = 2109–13 | date = November 2014 | pmid = 25427113 | doi = 10.1056/NEJMra1407298 | s2cid = 205116954 | url = http://www.escholarship.org/uc/item/08b9z9th }}</ref> Drinking during [[pregnancy]] may [[fetal alcohol spectrum disorders|harm the child's health]],<ref name=FAS2015>{{cite web|title=Fetal Alcohol Exposure|url=http://www.niaaa.nih.gov/alcohol-health/fetal-alcohol-exposure|access-date=9 May 2015|url-status=live|archive-url=https://web.archive.org/web/20150404182156/http://www.niaaa.nih.gov/alcohol-health/fetal-alcohol-exposure|archive-date=4 April 2015|date=14 September 2011}}</ref> and [[drunk driving]] increases the risk of traffic accidents. Alcoholism is also associated with increases in violent and non-violent crime.<ref>{{cite book |url=https://onlinelibrary.wiley.com/doi/book/10.1002/9781405165518 |title=The Blackwell Encyclopedia of Sociology |date=2007-02-15 |publisher=Wiley |isbn=978-1-4051-2433-1 |editor-last=Ritzer |editor-first=George |edition=1 |language=en |doi=10.1002/9781405165518.wbeosa039.pub2}}</ref> While alcoholism directly resulted in 139,000 deaths worldwide in 2013,<ref name="GDB2013">{{cite journal | title = Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013 | journal = Lancet | volume = 385 | issue = 9963 | pages = 117–71 | date = January 2015 | pmid = 25530442 | pmc = 4340604 | doi = 10.1016/S0140-6736(14)61682-2 | author1 =((GBD 2013 Mortality Causes of Death Collaborators)) }}</ref> in 2012 3.3 million deaths may be attributable globally to alcohol.<ref name=NIH2015Stats/>
+Alcohol is [[Addiction|addictive]], and heavy long-term alcohol use results in many negative health and social consequences. It can damage all the [[organ system]]s, but especially affects the brain, heart, liver, [[pancreas]] and [[immune system]].<ref name=DSM5 /><ref name=NIHHx /> Heavy alcohol usage can result in [[Alcohol use and sleep|trouble sleeping]], and severe cognitive issues like [[alcohol-related dementia|dementia]], [[Alcohol-related brain damage|brain damage]], or [[Wernicke–Korsakoff syndrome]]. Physical effects include [[Heart arrhythmia|irregular heartbeat]], an impaired immune response, liver [[cirrhosis]], [[alcohol and cancer|increased cancer risk]], and [[delirium tremens|severe withdrawal symptoms]] if stopped suddenly.<ref name=DSM5 /><ref name=NIHHx>{{cite web|title=Alcohol's Effects on the Body|url=http://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body|access-date=9 May 2015|url-status=live|archive-url=https://web.archive.org/web/20150603230352/http://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body|archive-date=3 June 2015|date=14 September 2011}}</ref><ref>{{cite journal | vauthors = Romeo J, Wärnberg J, Nova E, Díaz LE, Gómez-Martinez S, Marcos A | title = Moderate alcohol consumption and the immune system: a review | journal = The British Journal of Nutrition | volume = 98 | pages = S111-5 | date = October 2007 | issue = Suppl 1 | pmid = 17922947 | doi = 10.1017/S0007114507838049 | doi-access = free }}</ref> These health effects can reduce [[life expectancy]] by 10 years.<ref name=Schu2014>{{cite journal | vauthors = Schuckit MA | title = Recognition and management of withdrawal delirium (delirium tremens) | journal = The New England Journal of Medicine | volume = 371 | issue = 22 | pages = 2109–13 | date = November 2014 | pmid = 25427113 | doi = 10.1056/NEJMra1407298 | s2cid = 205116954 | url = http://www.escholarship.org/uc/item/08b9z9th | access-date = 1 July 2024 | archive-date = 13 February 2020 | archive-url = https://web.archive.org/web/20200213032901/https://escholarship.org/uc/item/08b9z9th | url-status = live }}</ref> Drinking during [[pregnancy]] may [[fetal alcohol spectrum disorders|harm the child's health]],<ref name=FAS2015>{{cite web|title=Fetal Alcohol Exposure|url=http://www.niaaa.nih.gov/alcohol-health/fetal-alcohol-exposure|access-date=9 May 2015|url-status=live|archive-url=https://web.archive.org/web/20150404182156/http://www.niaaa.nih.gov/alcohol-health/fetal-alcohol-exposure|archive-date=4 April 2015|date=14 September 2011}}</ref> and [[drunk driving]] increases the risk of traffic accidents. Alcoholism is also associated with increases in violent and non-violent crime.<ref>{{cite book |url=https://onlinelibrary.wiley.com/doi/book/10.1002/9781405165518 |title=The Blackwell Encyclopedia of Sociology |date=2007-02-15 |publisher=Wiley |isbn=978-1-4051-2433-1 |editor-last=Ritzer |editor-first=George |edition=1|doi=10.1002/9781405165518.wbeosa039.pub2 |access-date=1 July 2024 |archive-date=1 November 2023 |archive-url=https://web.archive.org/web/20231101144411/https://onlinelibrary.wiley.com/doi/book/10.1002/9781405165518 |url-status=live }}</ref> While alcoholism directly resulted in 139,000 deaths worldwide in 2013,<ref name="GDB2013">{{cite journal | title = Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013 | journal = Lancet | volume = 385 | issue = 9963 | pages = 117–71 | date = January 2015 | pmid = 25530442 | pmc = 4340604 | doi = 10.1016/S0140-6736(14)61682-2 | author1 =((GBD 2013 Mortality Causes of Death Collaborators)) }}</ref> in 2012 3.3 million deaths may be attributable globally to alcohol.<ref name=NIH2015Stats/>
 <!-- Cause and diagnosis-->
@@ Line 38: / Line 38: @@
 <!-- Prevention and treatment -->
-Treatment of alcoholism may take several forms.<ref name="Blondell-2005"/> Due to medical problems that can occur during withdrawal, [[alcohol detoxification|alcohol cessation]] should be controlled carefully.<ref name="Blondell-2005"/> One common method involves the use of [[benzodiazepine]] medications, such as [[diazepam]].<ref name="Blondell-2005"/> These can be taken while admitted to a health care institution or individually.<ref name="Blondell-2005">{{cite journal | vauthors = Blondell RD | title = Ambulatory detoxification of patients with alcohol dependence | journal = American Family Physician | volume = 71 | issue = 3 | pages = 495–502 | date = February 2005 | pmid = 15712624 }}</ref> The medications [[acamprosate]] or [[disulfiram]] may also be used to help prevent further drinking.<ref name=Test2014>{{cite journal | vauthors = Testino G, Leone S, Borro P | title = Treatment of alcohol dependence: recent progress and reduction of consumption | journal = Minerva Medica | volume = 105 | issue = 6 | pages = 447–66 | date = December 2014 | pmid = 25392958 }}</ref> Mental illness or other [[addiction]]s may complicate treatment.<ref>{{cite journal | vauthors = DeVido JJ, Weiss RD | title = Treatment of the depressed alcoholic patient | journal = Current Psychiatry Reports | volume = 14 | issue = 6 | pages = 610–8 | date = December 2012 | pmid = 22907336 | pmc = 3712746 | doi = 10.1007/s11920-012-0314-7 }}</ref> Various individual or group therapy or [[support group]]s are used to attempt to keep a person from returning to alcoholism.<ref name="Morgan-Lopez-2006">{{cite journal | vauthors = Morgan-Lopez AA, Fals-Stewart W | title = Analytic complexities associated with group therapy in substance abuse treatment research: problems, recommendations, and future directions | journal = Experimental and Clinical Psychopharmacology | volume = 14 | issue = 2 | pages = 265–73 | date = May 2006 | pmid = 16756430 | pmc = 4631029 | doi = 10.1037/1064-1297.14.2.265 }}</ref><ref>{{cite journal | vauthors = Albanese AP | title = Management of alcohol abuse | journal = Clinics in Liver Disease | volume = 16 | issue = 4 | pages = 737–62 | date = November 2012 | pmid = 23101980 | doi = 10.1016/j.cld.2012.08.006 }}</ref> Among them is the abstinence based [[Mutual aid (organization theory)|mutual aid]] fellowship [[Alcoholics Anonymous]] (AA). A 2020 scientific review found that clinical interventions encouraging increased participation in AA (AA/twelve step facilitation (AA/TSF))—resulted in higher abstinence rates over other clinical interventions, and most studies in the review found that AA/TSF led to lower health costs.{{efn|"Twelve-Step Facilitation (TSF) interventions include extended counseling, adopting some of the techniques and principles of AA, as well as brief interventions designed to link individuals to community AA groups."<ref>{{cite journal |doi=10.1002/14651858.CD012880.pub2 |pmid=32159228 |title=Alcoholics Anonymous and other 12-step programs for alcohol use disorder |year=2020 |last1=Kelly |first1=John F. |last2=Humphreys |first2=Keith |last3=Ferri |first3=Marica |journal=Cochrane Database of Systematic Reviews |volume=3 |issue=CD012880 |page=15 |pmc=7065341}}</ref>}}<ref name="Cochrane2020">{{cite journal |last1=Kelly |first1=John F. |last2=Humphreys |first2=Keith |last3=Ferri |first3=Marica |year=2020 |title=Alcoholics Anonymous and other 12-step programs for alcohol use disorder |journal=Cochrane Database of Systematic Reviews |volume=3 |issue=3 |pages=CD012880 |doi=10.1002/14651858.CD012880.pub2 |pmc=7065341 |pmid=32159228}}</ref><ref name="Cochrane2020distilled">{{cite journal |last1=Kelly |first1=John F. |last2=Abry |first2=Alexandra |last3=Ferri |first3=Marica |last4=Humphreys |first4=Keith |year=2020 |title=Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers |journal=Alcohol and Alcoholism |volume=55 |issue=6 |pages=641–651 |doi=10.1093/alcalc/agaa050 |pmc=8060988 |pmid=32628263}}</ref><ref>{{cite web |year=2020 |title=Alcoholics Anonymous most effective path to alcohol abstinence |url=https://med.stanford.edu/news/all-news/2020/03/alcoholics-anonymous-most-effective-path-to-alcohol-abstinence.html}}</ref>
+Treatment of alcoholism may take several forms.<ref name="Blondell-2005"/> Due to medical problems that can occur during withdrawal, [[alcohol detoxification|alcohol cessation]] should be controlled carefully.<ref name="Blondell-2005"/> One common method involves the use of [[benzodiazepine]] medications, such as [[diazepam]].<ref name="Blondell-2005"/> These can be taken while admitted to a health care institution or individually.<ref name="Blondell-2005">{{cite journal | vauthors = Blondell RD | title = Ambulatory detoxification of patients with alcohol dependence | journal = American Family Physician | volume = 71 | issue = 3 | pages = 495–502 | date = February 2005 | pmid = 15712624 }}</ref> The medications [[acamprosate]] or [[disulfiram]] may also be used to help prevent further drinking.<ref name=Test2014>{{cite journal | vauthors = Testino G, Leone S, Borro P | title = Treatment of alcohol dependence: recent progress and reduction of consumption | journal = Minerva Medica | volume = 105 | issue = 6 | pages = 447–66 | date = December 2014 | pmid = 25392958 }}</ref> Mental illness or other [[addiction]]s may complicate treatment.<ref>{{cite journal | vauthors = DeVido JJ, Weiss RD | title = Treatment of the depressed alcoholic patient | journal = Current Psychiatry Reports | volume = 14 | issue = 6 | pages = 610–8 | date = December 2012 | pmid = 22907336 | pmc = 3712746 | doi = 10.1007/s11920-012-0314-7 }}</ref> Various individual or group therapy or [[support group]]s are used to attempt to keep a person from returning to alcoholism.<ref name="Morgan-Lopez-2006">{{cite journal | vauthors = Morgan-Lopez AA, Fals-Stewart W | title = Analytic complexities associated with group therapy in substance abuse treatment research: problems, recommendations, and future directions | journal = Experimental and Clinical Psychopharmacology | volume = 14 | issue = 2 | pages = 265–73 | date = May 2006 | pmid = 16756430 | pmc = 4631029 | doi = 10.1037/1064-1297.14.2.265 }}</ref><ref>{{cite journal | vauthors = Albanese AP | title = Management of alcohol abuse | journal = Clinics in Liver Disease | volume = 16 | issue = 4 | pages = 737–62 | date = November 2012 | pmid = 23101980 | doi = 10.1016/j.cld.2012.08.006 }}</ref> Among them is the abstinence based [[Mutual aid (organization theory)|mutual aid]] fellowship [[Alcoholics Anonymous]] (AA). A 2020 scientific review found that clinical interventions encouraging increased participation in AA (AA/twelve step facilitation (AA/TSF))—resulted in higher abstinence rates over other clinical interventions, and most studies in the review found that AA/TSF led to lower health costs.{{efn|"Twelve-Step Facilitation (TSF) interventions include extended counseling, adopting some of the techniques and principles of AA, as well as brief interventions designed to link individuals to community AA groups."<ref>{{cite journal |doi=10.1002/14651858.CD012880.pub2 |pmid=32159228 |title=Alcoholics Anonymous and other 12-step programs for alcohol use disorder |year=2020 |last1=Kelly |first1=John F. |last2=Humphreys |first2=Keith |last3=Ferri |first3=Marica |journal=Cochrane Database of Systematic Reviews |volume=3 |issue=CD012880 |page=15 |pmc=7065341}}</ref>}}<ref name="Cochrane2020">{{cite journal |last1=Kelly |first1=John F. |last2=Humphreys |first2=Keith |last3=Ferri |first3=Marica |year=2020 |title=Alcoholics Anonymous and other 12-step programs for alcohol use disorder |journal=Cochrane Database of Systematic Reviews |volume=3 |issue=3 |pages=CD012880 |doi=10.1002/14651858.CD012880.pub2 |pmc=7065341 |pmid=32159228}}</ref><ref name="Cochrane2020distilled">{{cite journal |last1=Kelly |first1=John F. |last2=Abry |first2=Alexandra |last3=Ferri |first3=Marica |last4=Humphreys |first4=Keith |year=2020 |title=Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers |journal=Alcohol and Alcoholism |volume=55 |issue=6 |pages=641–651 |doi=10.1093/alcalc/agaa050 |pmc=8060988 |pmid=32628263}}</ref><ref>{{cite web |year=2020 |title=Alcoholics Anonymous most effective path to alcohol abstinence |url=https://med.stanford.edu/news/all-news/2020/03/alcoholics-anonymous-most-effective-path-to-alcohol-abstinence.html |access-date=1 July 2024 |archive-date=20 February 2022 |archive-url=https://web.archive.org/web/20220220224453/https://med.stanford.edu/news/all-news/2020/03/alcoholics-anonymous-most-effective-path-to-alcohol-abstinence.html |url-status=live }}</ref>
 Many terms, some [[Pejorative|slurs]] and some [[slang|informal]], have been used to refer to people affected by alcoholism such as ''tippler'', ''drunkard'', ''[[dipsomaniac]]'' and ''souse''.<ref>{{cite book|title=Chambers English Thesaurus|publisher=Allied Publishers|isbn=978-81-86062-04-3|page=175|url=https://books.google.com/books?id=IamKT5uk5lMC&pg=PA175}}</ref>
@@ Line 44: / Line 44: @@
 ==Signs and symptoms==
-The risk of alcohol dependence begins at low levels of drinking and increases directly with both the volume of alcohol consumed and a pattern of [[Binge drinking|drinking larger amounts on an occasion]], to the point of intoxication, which is sometimes called ''binge drinking''. Binge drinking is the most common pattern of alcoholism. It has different definitions and one of this defines it  as a pattern of drinking when a male has five or more drinks on an occasion or a female has at least four drinks on an occasion.<ref>{{cite web |title=Binge Drinking |url=https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm#:~:text=Binge%20drinking%20is%20the%20most,on%20an%20occasion%20for%20women |website=Center For Disease Control and Prevention | date=28 February 2024 |access-date=28 February 2024}}</ref>
+The risk of alcohol dependence begins at low levels of drinking and increases directly with both the volume of alcohol consumed and a pattern of [[Binge drinking|drinking larger amounts on an occasion]], to the point of intoxication, which is sometimes called ''binge drinking''. Binge drinking is the most common pattern of alcoholism. It has different definitions and one of this defines it as a pattern of drinking when a male has five or more drinks on an occasion or a female has at least four drinks on an occasion.<ref>{{cite web |title=Binge Drinking |url=https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm#:~:text=Binge%20drinking%20is%20the%20most,on%20an%20occasion%20for%20women |website=Center For Disease Control and Prevention |date=28 February 2024 |access-date=28 February 2024 |archive-date=12 May 2013 |archive-url=https://web.archive.org/web/20130512044035/http://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm#:~:text=Binge%20drinking%20is%20the%20most,on%20an%20occasion%20for%20women |url-status=live }}</ref>
 ===Long-term misuse===
@@ Line 62: / Line 62: @@
 {{See also|Long-term effects of alcohol consumption}}
-Having more than one drink a day for women or two drinks for men increases the risk of heart disease, [[high blood pressure]], [[atrial fibrillation]], and [[stroke]].<ref name="Kee2014">{{cite journal|vauthors=O'Keefe JH, Bhatti SK, Bajwa A, DiNicolantonio JJ, Lavie CJ|date=March 2014|title=Alcohol and cardiovascular health: the dose makes the poison…or the remedy|journal=Mayo Clinic Proceedings|volume=89|issue=3|pages=382–93|doi=10.1016/j.mayocp.2013.11.005|pmid=24582196|doi-access=free}}</ref> Risk is greater with [[binge drinking]], which may also result in violence or accidents. About 3.3&nbsp;million deaths (5.9% of all deaths) are believed to be due to alcohol each year.<ref name="NIH2015Stats" /> Alcoholism reduces a person's life expectancy by around ten years<ref name="Schu2014" /> and alcohol use is the third leading cause of early death in the United States.<ref name=Kee2014 /> Long-term alcohol misuse can cause a number of physical symptoms, including [[cirrhosis]] of the liver, [[pancreatitis]], [[epilepsy]], [[polyneuropathy]], [[Wernicke-Korsakoff syndrome|alcoholic dementia]], heart disease, nutritional deficiencies, [[Duodenal ulcer|peptic ulcers]]<ref>{{cite book |last=American Medical Association |title=Complete Medical Encyclopedia|url={{google books |plainurl=y |id=WGURAQAAMAAJ}} |year=2003|publisher=Random House Reference |location=New York |isbn=978-0-8129-9100-0|edition=First | chapter = Duodenal Ulcer | veditors = Leiken JS, Lipsky MS |page=485 }}</ref> and [[sexual dysfunction]], and can eventually be fatal. Other physical effects include an increased risk of developing [[cardiovascular disease]], [[malabsorption]], [[alcoholic liver disease]], and several [[cancer]]s. Damage to the [[central nervous system]] and [[peripheral nervous system]] can occur from sustained alcohol consumption.<ref>{{cite journal | vauthors = Müller D, Koch RD, von Specht H, Völker W, Münch EM | title = [Neurophysiologic findings in chronic alcohol abuse] | language = de | journal = Psychiatrie, Neurologie, und Medizinische Psychologie | volume = 37 | issue = 3 | pages = 129–32 | date = March 1985 | pmid = 2988001 }}</ref><ref>{{cite journal | vauthors = Testino G | title = Alcoholic diseases in hepato-gastroenterology: a point of view | journal = Hepato-Gastroenterology | volume = 55 | issue = 82–83 | pages = 371–7 | year = 2008 | pmid = 18613369 }}</ref> A wide range of immunologic defects can result and there may be a generalized skeletal fragility, in addition to a recognized tendency to accidental injury, resulting in a propensity for bone fractures.<ref>[http://pubs.niaaa.nih.gov/publications/10report/intro.pdf 10th Special Report to the U.S. Congress on Alcohol and Health] {{webarchive|url=https://web.archive.org/web/20120913074727/http://pubs.niaaa.nih.gov/publications/10report/intro.pdf |date=13 September 2012 }}, 2000, U.S. Department of Health and Human Services, Public Health Service National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism.</ref>
+Having more than one drink a day for women or two drinks for men increases the risk of heart disease, [[high blood pressure]], [[atrial fibrillation]], and [[stroke]].<ref name="Kee2014">{{cite journal|vauthors=O'Keefe JH, Bhatti SK, Bajwa A, DiNicolantonio JJ, Lavie CJ|date=March 2014|title=Alcohol and cardiovascular health: the dose makes the poison…or the remedy|journal=Mayo Clinic Proceedings|volume=89|issue=3|pages=382–93|doi=10.1016/j.mayocp.2013.11.005|pmid=24582196|doi-access=free}}</ref> Risk is greater with [[binge drinking]], which may also result in violence or accidents. About 3.3&nbsp;million deaths (5.9% of all deaths) are believed to be due to alcohol each year.<ref name="NIH2015Stats" /> Alcoholism reduces a person's life expectancy by around ten years<ref name="Schu2014" /> and alcohol use is the third leading cause of early death in the United States.<ref name=Kee2014 /> Long-term alcohol misuse can cause a number of physical symptoms, including [[cirrhosis]] of the liver, [[pancreatitis]], [[epilepsy]], [[polyneuropathy]], [[Wernicke-Korsakoff syndrome|alcoholic dementia]], heart disease, nutritional deficiencies, [[Duodenal ulcer|peptic ulcers]]<ref>{{cite book |last=American Medical Association |title=Complete Medical Encyclopedia |url=https://books.google.com/books?id=WGURAQAAMAAJ |year=2003 |publisher=Random House Reference |location=New York |isbn=978-0-8129-9100-0 |edition=First |chapter=Duodenal Ulcer |veditors=Leiken JS, Lipsky MS |page=485 |access-date=1 July 2024 |archive-date=14 January 2023 |archive-url=https://web.archive.org/web/20230114105316/https://books.google.com/books?id=WGURAQAAMAAJ |url-status=live }}</ref> and [[sexual dysfunction]], and can eventually be fatal. Other physical effects include an increased risk of developing [[cardiovascular disease]], [[malabsorption]], [[alcoholic liver disease]], and several cancers such as [[breast cancer]] and [[head and neck cancer]].<ref name=":6">{{Cite journal |last1=Gormley |first1=Mark |last2=Creaney |first2=Grant |last3=Schache |first3=Andrew |last4=Ingarfield |first4=Kate |last5=Conway |first5=David I. |date=2022-11-11 |title=Reviewing the epidemiology of head and neck cancer: definitions, trends and risk factors |journal=British Dental Journal|volume=233 |issue=9 |pages=780–786 |doi=10.1038/s41415-022-5166-x |issn=0007-0610 |pmc=9652141 |pmid=36369568}}</ref> Damage to the [[central nervous system]] and [[peripheral nervous system]] can occur from sustained alcohol consumption.<ref>{{cite journal | vauthors = Müller D, Koch RD, von Specht H, Völker W, Münch EM | title = [Neurophysiologic findings in chronic alcohol abuse] | language = de | journal = Psychiatrie, Neurologie, und Medizinische Psychologie | volume = 37 | issue = 3 | pages = 129–32 | date = March 1985 | pmid = 2988001 }}</ref><ref>{{cite journal | vauthors = Testino G | title = Alcoholic diseases in hepato-gastroenterology: a point of view | journal = Hepato-Gastroenterology | volume = 55 | issue = 82–83 | pages = 371–7 | year = 2008 | pmid = 18613369 }}</ref> A wide range of immunologic defects can result and there may be a generalized skeletal fragility, in addition to a recognized tendency to accidental injury, resulting in a propensity for bone fractures.<ref>[http://pubs.niaaa.nih.gov/publications/10report/intro.pdf 10th Special Report to the U.S. Congress on Alcohol and Health] {{webarchive|url=https://web.archive.org/web/20120913074727/http://pubs.niaaa.nih.gov/publications/10report/intro.pdf |date=13 September 2012 }}, 2000, U.S. Department of Health and Human Services, Public Health Service National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism.</ref>
-Women develop long-term complications of alcohol dependence more rapidly than do men, women also have a higher mortality rate from alcoholism than men.<ref name="Blume Laura N., Nielson Nancy H., Riggs Joseph A., et all 1998 861–870"/> Examples of long-term complications include brain, heart, and liver damage<ref name="Walter H., Gutierrez K., Ramskogler K., Hertling I., Dvorak A., Lesch O.M., et al. 2003 253–268" /> and an [[alcohol and breast cancer|increased risk of breast cancer]]. Additionally, heavy drinking over time has been found to have a negative effect on reproductive functioning in women. This results in reproductive dysfunction such as [[anovulation]], decreased ovarian mass, problems or irregularity of the [[menstrual cycle]], and early [[menopause]].<ref name="Blume Laura N., Nielson Nancy H., Riggs Joseph A., et all 1998 861–870" /> Alcoholic [[ketoacidosis]] can occur in individuals who chronically misuse alcohol and have a recent history of [[binge drinking]].<ref name="Mihai-">{{cite journal | vauthors = Mihai B, Lăcătuşu C, Graur M | title = [Alcoholic ketoacidosis] | journal = Revista Medico-Chirurgicala a Societatii de Medici Si Naturalisti Din Iasi | volume = 112 | issue = 2 | pages = 321–6 | date = April–June 2008 | pmid = 19294998 }}</ref><ref name="Sibaï-2005">{{cite journal | vauthors = Sibaï K, Eggimann P | title = [Alcoholic ketoacidosis: not rare cause of metabolic acidosis] | journal = Revue Médicale Suisse | volume = 1 | issue = 32 | pages = 2106, 2108–10, 2112–5 | date = September 2005 | pmid = 16238232 }}</ref> The amount of alcohol that can be biologically processed and its effects differ between sexes. Equal dosages of alcohol consumed by men and women generally result in women having higher [[blood alcohol concentration]]s (BACs), since women generally have a lower weight and higher percentage of body fat and therefore a lower volume of distribution for alcohol than men.<ref name="pmid23101976">{{cite journal | vauthors = Cederbaum AI | title = Alcohol metabolism | journal = Clinics in Liver Disease | volume = 16 | issue = 4 | pages = 667–85 | date = November 2012 | pmid = 23101976 | pmc = 3484320 | doi = 10.1016/j.cld.2012.08.002 }}</ref>
+Women develop long-term complications of alcohol dependence more rapidly than do men, women also have a higher mortality rate from alcoholism than men.<ref name="Blume Laura N., Nielson Nancy H., Riggs Joseph A., et all 1998 861–870"/> Examples of long-term complications include brain, heart, and liver damage<ref name="Walter H., Gutierrez K., Ramskogler K., Hertling I., Dvorak A., Lesch O.M., et al. 2003 253–268" /> and an [[alcohol and breast cancer|increased risk of breast cancer]]. Additionally, heavy drinking over time has been found to have a negative effect on reproductive functioning in women. This results in reproductive dysfunction such as [[anovulation]], decreased ovarian mass, problems or irregularity of the [[menstrual cycle]], and early [[menopause]].<ref name="Blume Laura N., Nielson Nancy H., Riggs Joseph A., et all 1998 861–870" /> Alcoholic [[ketoacidosis]] can occur in individuals who chronically misuse alcohol and have a recent history of [[binge drinking]].<ref name="Mihai-">{{cite journal | vauthors = Mihai B, Lăcătuşu C, Graur M | title = [Alcoholic ketoacidosis] | journal = Revista Medico-Chirurgicala a Societatii de Medici Si Naturalisti Din Iasi | volume = 112 | issue = 2 | pages = 321–6 | date = April–June 2008 | pmid = 19294998 }}</ref><ref name="Sibaï-2005">{{cite journal | vauthors = Sibaï K, Eggimann P | title = [Alcoholic ketoacidosis: not rare cause of metabolic acidosis] | journal = Revue Médicale Suisse | volume = 1 | issue = 32 | pages = 2106, 2108–10, 2112–5 | date = September 2005 | doi = 10.53738/REVMED.2005.1.32.2106 | pmid = 16238232 }}</ref> The amount of alcohol that can be biologically processed and its effects differ between sexes. Equal dosages of alcohol consumed by men and women generally result in women having higher [[blood alcohol concentration]]s (BACs), since women generally have a lower weight and higher percentage of body fat and therefore a lower volume of distribution for alcohol than men.<ref name="pmid23101976">{{cite journal | vauthors = Cederbaum AI | title = Alcohol metabolism | journal = Clinics in Liver Disease | volume = 16 | issue = 4 | pages = 667–85 | date = November 2012 | pmid = 23101976 | pmc = 3484320 | doi = 10.1016/j.cld.2012.08.002 }}</ref>
 ====Psychiatric====
 Long-term misuse of alcohol can cause a wide range of [[mental health]] problems. Severe [[cognitive]] problems are common; approximately 10% of all dementia cases are related to alcohol consumption, making it the second leading cause of [[dementia]].<ref name="aamaibnc">{{cite web |url=http://www.eurekalert.org/pub_releases/2008-07/econ-ma070808.php |title=Alcoholism-associated molecular adaptations in brain neurocognitive circuits | vauthors = Bakalkin G |date=8 July 2008 |website=Eurekalert.org |access-date=11 January 2012 |url-status=live |archive-url=https://web.archive.org/web/20111130152434/http://www.eurekalert.org/pub_releases/2008-07/econ-ma070808.php |archive-date=30 November 2011 }}</ref> Excessive alcohol use causes [[Brain damage|damage to brain function]], and psychological health can be increasingly affected over time.<ref>{{cite journal | vauthors = Oscar-Berman M, Marinkovic K | title = Alcoholism and the brain: an overview | journal = Alcohol Research & Health | volume = 27 | issue = 2 | pages = 125–33 | year = 2003 | pmid = 15303622 | pmc = 6668884 }}</ref> [[Social skills]] are significantly impaired in people with alcoholism due to the neurotoxic effects of alcohol on the brain, especially the [[prefrontal cortex]] area of the brain. The social skills that are impaired by alcohol use disorder include impairments in perceiving facial emotions, [[Prosody (linguistics)|prosody]], perception problems, and [[theory of mind]] deficits; the ability to understand humor is also impaired in people who misuse alcohol.<ref name="pmid18412750">{{cite journal | vauthors = Uekermann J, Daum I | title = Social cognition in alcoholism: a link to prefrontal cortex dysfunction? | journal = Addiction | volume = 103 | issue = 5 | pages = 726–35 | date = May 2008 | pmid = 18412750 | doi = 10.1111/j.1360-0443.2008.02157.x }}</ref> Psychiatric disorders are common in people with alcohol use disorders, with as many as 25% also having severe psychiatric disturbances. The most prevalent psychiatric symptoms are [[anxiety disorder|anxiety]] and [[Major depressive disorder|depression]] disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued abstinence.<ref>{{cite journal | vauthors = Wetterling T, Junghanns K | title = Psychopathology of alcoholics during withdrawal and early abstinence | journal = European Psychiatry | volume = 15 | issue = 8 | pages = 483–8 | date = December 2000 | pmid = 11175926 | doi = 10.1016/S0924-9338(00)00519-8 | s2cid = 24094651 }}</ref> [[Psychosis]], [[confusion]], and [[organic brain syndrome]] may be caused by alcohol misuse, which can lead to a misdiagnosis such as [[schizophrenia]].<ref>{{cite journal | vauthors = Schuckit MA | title = Alcoholism and other psychiatric disorders | journal = Hospital & Community Psychiatry | volume = 34 | issue = 11 | pages = 1022–7 | date = November 1983 | pmid = 6642446 | doi = 10.1176/ps.34.11.1022 }}</ref> [[Panic disorder]] can develop or worsen as a direct result of long-term alcohol misuse.<ref>{{cite journal | vauthors = Cowley DS | title = Alcohol abuse, substance abuse, and panic disorder | journal = The American Journal of Medicine | volume = 92 | issue = 1A | pages = 41S–48S | date = January 1992 | pmid = 1346485 | doi = 10.1016/0002-9343(92)90136-Y }}</ref><ref>{{cite journal | vauthors = Cosci F, Schruers KR, Abrams K, Griez EJ | title = Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship | journal = The Journal of Clinical Psychiatry | volume = 68 | issue = 6 | pages = 874–80 | date = June 2007 | pmid = 17592911 | doi = 10.4088/JCP.v68n0608 }}</ref>
-The co-occurrence of [[major depressive disorder]] and alcoholism is well documented.<ref>{{cite journal | vauthors = Grant BF, Harford TC | title = Comorbidity between DSM-IV alcohol use disorders and major depression: results of a national survey | journal = Drug and Alcohol Dependence | volume = 39 | issue = 3 | pages = 197–206 | date = October 1995 | pmid = 8556968 | doi = 10.1016/0376-8716(95)01160-4 | url = https://zenodo.org/record/1258497 }}</ref><ref>{{cite journal | vauthors = Kandel DB, Huang FY, Davies M | title = Comorbidity between patterns of substance use dependence and psychiatric syndromes | journal = Drug and Alcohol Dependence | volume = 64 | issue = 2 | pages = 233–41 | date = October 2001 | pmid = 11543993 | doi = 10.1016/S0376-8716(01)00126-0 | author-link1 = Denise Kandel }}</ref><ref>{{cite book | vauthors = Cornelius JR, Bukstein O, Salloum I, Clark D | title = Recent Developments in Alcoholism | chapter = Alcohol and psychiatric comorbidity | series = Recent Dev Alcohol | volume = 16 | pages = [https://archive.org/details/recentdevelopment00gala/page/361 361–74] | year = 2003 | pmid = 12638646 | doi = 10.1007/0-306-47939-7_24 | chapter-url = https://archive.org/details/recentdevelopment00gala/page/361 | isbn = 978-0-306-47258-9 | issn = 0738-422X | publisher = Kluwer Academic/Plenum Publishers }}</ref> Among those with [[comorbid]] occurrences, a distinction is commonly made between depressive episodes that remit with alcohol abstinence ("substance-induced"), and depressive episodes that are primary and do not remit with abstinence ("independent" episodes).<ref>{{cite journal | vauthors = Schuckit MA, Tipp JE, Bergman M, Reich W, Hesselbrock VM, Smith TL | title = Comparison of induced and independent major depressive disorders in 2,945 alcoholics | journal = The American Journal of Psychiatry | volume = 154 | issue = 7 | pages = 948–57 | date = July 1997 | pmid = 9210745 | doi = 10.1176/ajp.154.7.948 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Schuckit MA, Tipp JE, Bucholz KK, Nurnberger JI, Hesselbrock VM, Crowe RR, Kramer J | title = The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls | journal = Addiction | volume = 92 | issue = 10 | pages = 1289–304 | date = October 1997 | pmid = 9489046 | doi = 10.1111/j.1360-0443.1997.tb02848.x | s2cid = 14958283 }}</ref><ref>{{cite journal | vauthors = Schuckit MA, Smith TL, Danko GP, Pierson J, Trim R, Nurnberger JI, Kramer J, Kuperman S, Bierut LJ, Hesselbrock V | title = A comparison of factors associated with substance-induced versus independent depressions | journal = Journal of Studies on Alcohol and Drugs | volume = 68 | issue = 6 | pages = 805–12 | date = November 2007 | pmid = 17960298 | doi = 10.15288/jsad.2007.68.805 | s2cid = 17528609 }}</ref> Additional use of other drugs may increase the risk of depression.<ref>{{cite journal | vauthors = Schuckit M | title = Alcoholic patients with secondary depression | journal = The American Journal of Psychiatry | volume = 140 | issue = 6 | pages = 711–4 | date = June 1983 | pmid = 6846629 | doi = 10.1176/ajp.140.6.711 }}</ref> Psychiatric disorders differ depending on gender. Women who have alcohol-use disorders often have a co-occurring psychiatric diagnosis such as [[major depression]], [[anxiety]], [[panic disorder]], [[bulimia]], [[post-traumatic stress disorder]] (PTSD), or [[borderline personality disorder]]. Men with alcohol-use disorders more often have a co-occurring diagnosis of [[narcissistic personality disorder|narcissistic]] or [[antisocial personality disorder]], [[bipolar disorder]], [[schizophrenia]], [[impulse disorder]]s or [[attention deficit/hyperactivity disorder]] (ADHD).<ref name="Karrol_2002">{{cite journal| vauthors = Karrol BR |s2cid=73186615 |title=Women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners |journal=Journal of Social Work |volume=2 |issue=3 |pages=337–56 |year=2002 |doi=10.1177/146801730200200305 }}</ref> Women with alcohol use disorder are more likely to experience physical or [[sexual assault]], abuse, and [[domestic violence]] than women in the general population,<ref name="Karrol_2002" /> which can lead to higher instances of psychiatric disorders and greater dependence on alcohol.
+The co-occurrence of [[major depressive disorder]] and alcoholism is well documented.<ref>{{cite journal | vauthors = Grant BF, Harford TC | title = Comorbidity between DSM-IV alcohol use disorders and major depression: results of a national survey | journal = Drug and Alcohol Dependence | volume = 39 | issue = 3 | pages = 197–206 | date = October 1995 | pmid = 8556968 | doi = 10.1016/0376-8716(95)01160-4 | url = https://zenodo.org/record/1258497 | access-date = 1 July 2024 | archive-date = 28 November 2020 | archive-url = https://web.archive.org/web/20201128214542/https://zenodo.org/record/1258497 | url-status = live }}</ref><ref>{{cite journal | vauthors = Kandel DB, Huang FY, Davies M | title = Comorbidity between patterns of substance use dependence and psychiatric syndromes | journal = Drug and Alcohol Dependence | volume = 64 | issue = 2 | pages = 233–41 | date = October 2001 | pmid = 11543993 | doi = 10.1016/S0376-8716(01)00126-0 | author-link1 = Denise Kandel }}</ref><ref>{{cite book | vauthors = Cornelius JR, Bukstein O, Salloum I, Clark D | title = Recent Developments in Alcoholism | chapter = Alcohol and psychiatric comorbidity | series = Recent Dev Alcohol | volume = 16 | pages = [https://archive.org/details/recentdevelopment00gala/page/361 361–74] | year = 2003 | pmid = 12638646 | doi = 10.1007/0-306-47939-7_24 | chapter-url = https://archive.org/details/recentdevelopment00gala/page/361 | isbn = 978-0-306-47258-9 | issn = 0738-422X | publisher = Kluwer Academic/Plenum Publishers }}</ref> Among those with [[comorbid]] occurrences, a distinction is commonly made between depressive episodes that remit with alcohol abstinence ("substance-induced"), and depressive episodes that are primary and do not remit with abstinence ("independent" episodes).<ref>{{cite journal | vauthors = Schuckit MA, Tipp JE, Bergman M, Reich W, Hesselbrock VM, Smith TL | title = Comparison of induced and independent major depressive disorders in 2,945 alcoholics | journal = The American Journal of Psychiatry | volume = 154 | issue = 7 | pages = 948–57 | date = July 1997 | pmid = 9210745 | doi = 10.1176/ajp.154.7.948 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Schuckit MA, Tipp JE, Bucholz KK, Nurnberger JI, Hesselbrock VM, Crowe RR, Kramer J | title = The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls | journal = Addiction | volume = 92 | issue = 10 | pages = 1289–304 | date = October 1997 | pmid = 9489046 | doi = 10.1111/j.1360-0443.1997.tb02848.x | s2cid = 14958283 }}</ref><ref>{{cite journal | vauthors = Schuckit MA, Smith TL, Danko GP, Pierson J, Trim R, Nurnberger JI, Kramer J, Kuperman S, Bierut LJ, Hesselbrock V | title = A comparison of factors associated with substance-induced versus independent depressions | journal = Journal of Studies on Alcohol and Drugs | volume = 68 | issue = 6 | pages = 805–12 | date = November 2007 | pmid = 17960298 | doi = 10.15288/jsad.2007.68.805 | s2cid = 17528609 }}</ref> Additional use of other drugs may increase the risk of depression.<ref>{{cite journal | vauthors = Schuckit M | title = Alcoholic patients with secondary depression | journal = The American Journal of Psychiatry | volume = 140 | issue = 6 | pages = 711–4 | date = June 1983 | pmid = 6846629 | doi = 10.1176/ajp.140.6.711 }}</ref> Psychiatric disorders differ depending on gender. Women who have alcohol-use disorders often have a co-occurring psychiatric diagnosis such as [[major depression]], [[anxiety]], [[panic disorder]], [[bulimia]], [[post-traumatic stress disorder]] (PTSD), or [[borderline personality disorder]]. Men with alcohol-use disorders more often have a co-occurring diagnosis of [[narcissistic personality disorder|narcissistic]] or [[antisocial personality disorder]], [[bipolar disorder]], [[schizophrenia]], [[impulse disorder]]s or [[attention deficit/hyperactivity disorder]] (ADHD).<ref name="Karrol_2002">{{cite journal| vauthors = Karrol BR |s2cid=73186615 |title=Women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners |journal=Journal of Social Work |volume=2 |issue=3 |pages=337–56 |year=2002 |doi=10.1177/146801730200200305 }}</ref> Women with alcohol use disorder are more likely to experience physical or [[sexual assault]], abuse, and [[domestic violence]] than women in the general population,<ref name="Karrol_2002" /> which can lead to higher instances of psychiatric disorders and greater dependence on alcohol.
 ====Social effects====
 {{See also|Drug-related crime}}
-Serious social problems arise from alcohol use disorder; these dilemmas are caused by the pathological changes in the brain and the intoxicating effects of alcohol.<ref name="aamaibnc"/><ref name="Jessica Kingsley Publishers"/> Alcohol misuse is associated with an increased risk of committing criminal offences, including [[child abuse]], [[domestic violence]], [[rape]], [[burglary]] and [[assault]].<ref name="drug_use_a_reference_handbook">{{cite book| last1 = Isralowitz | first1 = Richard | title = Drug use: a reference handbook | url = {{google books |plainurl=y |id=X0mxxfbIbp4C}} | year = 2004 | publisher = ABC-CLIO | location = Santa Barbara, CA | isbn = 978-1-57607-708-5 | pages = 122–23}}</ref> Alcoholism is associated with [[termination of employment|loss of employment]],<ref>{{cite book| last1 = Langdana | first1 = Farrokh K. | title = Macroeconomic Policy: Demystifying Monetary and Fiscal Policy | url = {{google books |plainurl=y |id=GCYWQn79JYwC}} | year=2009 | publisher = Springer | edition = 2nd | isbn = 978-0-387-77665-1 | page = 81 }}</ref> which can lead to financial problems. Drinking at inappropriate times and behavior caused by reduced judgment can lead to legal consequences, such as criminal charges for [[drunk driving]]<ref name="abd2009">{{cite book| last1 = Gifford | first1 = Maria | title = Alcoholism (Biographies of Disease) | year=2009 | publisher = Greenwood Press | url = {{google books |plainurl=y |id=2OJV12astRUC|page=89}} | isbn = 978-0-313-35908-8 | pages = 89–91 }}</ref> or public disorder, or civil penalties for [[tort]]ious behavior. An alcoholic's behavior and mental impairment while drunk can profoundly affect those surrounding him and lead to isolation from family and friends. This isolation can lead to [[relational disorder|marital conflict]] and [[divorce]], or contribute to [[domestic violence]]. Alcoholism can also lead to [[child neglect]], with subsequent lasting damage to the emotional development of children of people with alcohol use disorders.<ref name="tcemh2006">{{cite book |last1=Schadé |first1=Johannes Petrus |title=The Complete Encyclopedia of Medicine and Health |year=2006 |publisher=Foreign Media Books |url={{google books |plainurl=y |id=j8DuEHxSCU4C|page=132}} |isbn=978-1-60136-001-4 |pages=132–33 }}</ref> For this reason, children of people with alcohol use disorders can develop a number of emotional problems. For example, they can become afraid of their parents, because of their unstable mood behaviors. They may develop shame over their inadequacy to liberate their parents from alcoholism and, as a result of this, may develop self-image problems, which can lead to depression.<ref>{{cite web |last=Gold |first=Mark |title=Children of Alcoholics |url=http://psychcentral.com/lib/2006/children-of-alcoholics/ |publisher=Psych Central |access-date=27 November 2011 |url-status=live |archive-url=https://web.archive.org/web/20111116010950/http://psychcentral.com/lib/2006/children-of-alcoholics/ |archive-date=16 November 2011 }}</ref>
+Serious social problems arise from alcohol use disorder; these dilemmas are caused by the pathological changes in the brain and the intoxicating effects of alcohol.<ref name="aamaibnc"/><ref name="Jessica Kingsley Publishers"/> Alcohol misuse is associated with an increased risk of committing criminal offences, including [[child abuse]], [[domestic violence]], [[rape]], [[burglary]] and [[assault]].<ref name="drug_use_a_reference_handbook">{{cite book | last1 = Isralowitz | first1 = Richard | title = Drug use: a reference handbook | url = https://books.google.com/books?id=X0mxxfbIbp4C | year = 2004 | publisher = ABC-CLIO | location = Santa Barbara, CA | isbn = 978-1-57607-708-5 | pages = 122–23 | access-date = 1 July 2024 | archive-date = 14 January 2023 | archive-url = https://web.archive.org/web/20230114105315/https://books.google.com/books?id=X0mxxfbIbp4C | url-status = live }}</ref> Alcoholism is associated with [[termination of employment|loss of employment]],<ref>{{cite book | last1 = Langdana | first1 = Farrokh K. | title = Macroeconomic Policy: Demystifying Monetary and Fiscal Policy | url = https://books.google.com/books?id=GCYWQn79JYwC | year = 2009 | publisher = Springer | edition = 2nd | isbn = 978-0-387-77665-1 | page = 81 | access-date = 1 July 2024 | archive-date = 14 January 2023 | archive-url = https://web.archive.org/web/20230114105316/https://books.google.com/books?id=GCYWQn79JYwC | url-status = live }}</ref> which can lead to financial problems. Drinking at inappropriate times and behavior caused by reduced judgment can lead to legal consequences, such as criminal charges for [[drunk driving]]<ref name="abd2009">{{cite book| last1 = Gifford | first1 = Maria | title = Alcoholism (Biographies of Disease) | year=2009 | publisher = Greenwood Press | url = {{google books |plainurl=y |id=2OJV12astRUC|page=89}} | isbn = 978-0-313-35908-8 | pages = 89–91 }}</ref> or public disorder, or civil penalties for [[tort]]ious behavior. An alcoholic's behavior and mental impairment while drunk can profoundly affect those surrounding him and lead to isolation from family and friends. This isolation can lead to [[relational disorder|marital conflict]] and [[divorce]], or contribute to [[domestic violence]]. Alcoholism can also lead to [[child neglect]], with subsequent lasting damage to the emotional development of children of people with alcohol use disorders.<ref name="tcemh2006">{{cite book |last1=Schadé |first1=Johannes Petrus |title=The Complete Encyclopedia of Medicine and Health |year=2006 |publisher=Foreign Media Books |url={{google books |plainurl=y |id=j8DuEHxSCU4C|page=132}} |isbn=978-1-60136-001-4 |pages=132–33 }}</ref> For this reason, children of people with alcohol use disorders can develop a number of emotional problems. For example, they can become afraid of their parents, because of their unstable mood behaviors. They may develop shame over their inadequacy to liberate their parents from alcoholism and, as a result of this, may develop self-image problems, which can lead to depression.<ref>{{cite web |last=Gold |first=Mark |title=Children of Alcoholics |url=http://psychcentral.com/lib/2006/children-of-alcoholics/ |publisher=Psych Central |access-date=27 November 2011 |url-status=live |archive-url=https://web.archive.org/web/20111116010950/http://psychcentral.com/lib/2006/children-of-alcoholics/ |archive-date=16 November 2011 }}</ref>
 ===Alcohol withdrawal===
@@ Line 81: / Line 81: @@
 [[File:A maniacal man is visited in prison by his children, all rui Wellcome V0019408.jpg|thumb|[[The Bottle (etchings)|"The bottle has done its work"]]. Reproduction of an etching by G. Cruikshank, 1847.]]
-As with similar substances with a sedative-hypnotic mechanism, such as [[barbiturates]] and [[benzodiazepines]], withdrawal from alcohol dependence can be fatal if it is not properly managed.<ref name="Jessica Kingsley Publishers"/><ref>{{cite book|last1=Galanter |first1=Marc |last2=Kleber |first2=Herbert D. |title=The American Psychiatric Publishing Textbook of Substance Abuse Treatment |url={{google books |plainurl=y |id=6wdJgejlQzYC|page=58}} |edition=4th |year=2008 |publisher=American Psychiatric Publishing Inc |isbn=978-1-58562-276-4 |page=58 }}</ref> Alcohol's primary effect is the increase in stimulation of the [[GABAA receptor|GABA<sub>A</sub> receptor]], promoting [[central nervous system]] depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in [[drug tolerance|tolerance]] and [[physical dependence]]. When alcohol consumption is stopped too abruptly, the person's nervous system experiences uncontrolled [[synapse]] firing. This can result in symptoms that include [[anxiety (mood)|anxiety]], life-threatening [[seizure]]s, [[delirium tremens]], hallucinations, shakes and possible [[heart failure]].<ref name="Medical toxicology">{{cite book|last1=Dart |first1=Richard C. |title=Medical Toxicology |url={{google books |plainurl=y |id=qDf3AO8nILoC|page=139}} |edition=3rd |year=2003 |publisher=Lippincott Williams & Wilkins |isbn=978-0-7817-2845-4 |pages=139–40}}</ref><ref>{{cite journal | vauthors = Idemudia SO, Bhadra S, Lal H | title = The pentylenetetrazol-like interoceptive stimulus produced by ethanol withdrawal is potentiated by bicuculline and picrotoxinin | journal = Neuropsychopharmacology | volume = 2 | issue = 2 | pages = 115–22 | date = June 1989 | pmid = 2742726 | doi = 10.1016/0893-133X(89)90014-6 }}</ref> Other [[neurotransmitter]] systems are also involved, especially [[dopamine]], [[NMDA]] and [[glutamate]].<ref name="Hoffman-1996"/><ref>{{cite journal | vauthors = Chastain G | s2cid = 40043433 | title = Alcohol, neurotransmitter systems, and behavior | journal = The Journal of General Psychology | volume = 133 | issue = 4 | pages = 329–35 | date = October 2006 | pmid = 17128954 | doi = 10.3200/GENP.133.4.329-335 }}</ref>
+As with similar substances with a [[sedative]]-hypnotic mechanism, such as [[barbiturates]] and [[benzodiazepines]], withdrawal from alcohol dependence can be fatal if it is not properly managed.<ref name="Jessica Kingsley Publishers"/><ref>{{cite book |last1=Galanter |first1=Marc |last2=Kleber |first2=Herbert D. |title=The American Psychiatric Publishing Textbook of Substance Abuse Treatment |url=https://books.google.com/books?id=6wdJgejlQzYC&pg=PA58 |edition=4th |year=2008 |publisher=American Psychiatric Publishing Inc |isbn=978-1-58562-276-4 |page=58 |access-date=1 July 2024 |archive-date=5 February 2023 |archive-url=https://web.archive.org/web/20230205013806/https://books.google.com/books?id=6wdJgejlQzYC&pg=PA58 |url-status=live }}</ref> Alcohol's primary effect is the increase in stimulation of the [[GABAA receptor|GABA<sub>A</sub> receptor]], promoting [[central nervous system]] depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in [[drug tolerance|tolerance]] and [[physical dependence]]. When alcohol consumption is stopped too abruptly, the person's nervous system experiences uncontrolled [[synapse]] firing. This can result in symptoms that include [[anxiety (mood)|anxiety]], life-threatening [[seizure]]s, [[delirium tremens]], hallucinations, shakes and possible [[heart failure]].<ref name="Medical toxicology">{{cite book|last1=Dart |first1=Richard C. |title=Medical Toxicology |url={{google books |plainurl=y |id=qDf3AO8nILoC|page=139}} |edition=3rd |year=2003 |publisher=Lippincott Williams & Wilkins |isbn=978-0-7817-2845-4 |pages=139–40}}</ref><ref>{{cite journal | vauthors = Idemudia SO, Bhadra S, Lal H | title = The pentylenetetrazol-like interoceptive stimulus produced by ethanol withdrawal is potentiated by bicuculline and picrotoxinin | journal = Neuropsychopharmacology | volume = 2 | issue = 2 | pages = 115–22 | date = June 1989 | pmid = 2742726 | doi = 10.1016/0893-133X(89)90014-6 }}</ref> Other [[neurotransmitter]] systems are also involved, especially [[dopamine]], [[NMDA]] and [[glutamate]].<ref name="Hoffman-1996"/><ref>{{cite journal | vauthors = Chastain G | s2cid = 40043433 | title = Alcohol, neurotransmitter systems, and behavior | journal = The Journal of General Psychology | volume = 133 | issue = 4 | pages = 329–35 | date = October 2006 | pmid = 17128954 | doi = 10.3200/GENP.133.4.329-335 }}</ref>
-Severe acute withdrawal symptoms such as [[delirium tremens]] and seizures rarely occur after 1-week post cessation of alcohol. The acute withdrawal phase can be defined as lasting between one and three weeks. In the period of 3–6 weeks following cessation, anxiety, depression, fatigue, and sleep disturbance are common.<ref name="pmid20148778">{{cite journal | vauthors = Heilig M, Egli M, Crabbe JC, Becker HC | title = Acute withdrawal, protracted abstinence and negative affect in alcoholism: are they linked? | journal = Addiction Biology | volume = 15 | issue = 2 | pages = 169–84 | date = April 2010 | pmid = 20148778 | pmc = 3268458 | doi = 10.1111/j.1369-1600.2009.00194.x }}</ref> Similar post-acute withdrawal symptoms have also been observed in animal models of alcohol dependence and withdrawal.<ref>{{cite book | last1 = Johnson | first1 = Bankole A. | title = Addiction medicine: science and practice | url = {{google books |plainurl=y |id=zvbr4Zn9S9MC|page=342}} | year = 2011 | publisher = Springer | location = New York | isbn = 978-1-4419-0337-2 | pages = 301–03 | url-status = live | archive-url = https://web.archive.org/web/20151201092622/https://books.google.com/books?id=zvbr4Zn9S9MC&pg=PA342 | archive-date = 1 December 2015 | df = dmy-all }}</ref>
+Severe acute withdrawal symptoms such as [[delirium tremens]] and seizures rarely occur after 1-week post cessation of alcohol. The acute withdrawal phase can be defined as lasting between one and three weeks. In the period of 3–6 weeks following cessation, anxiety, depression, fatigue, and sleep disturbance are common.<ref name="pmid20148778">{{cite journal | vauthors = Heilig M, Egli M, Crabbe JC, Becker HC | title = Acute withdrawal, protracted abstinence and negative affect in alcoholism: are they linked? | journal = Addiction Biology | volume = 15 | issue = 2 | pages = 169–84 | date = April 2010 | pmid = 20148778 | pmc = 3268458 | doi = 10.1111/j.1369-1600.2009.00194.x }}</ref> Similar post-acute withdrawal symptoms have also been observed in animal models of alcohol dependence and withdrawal.<ref>{{cite book | last1 = Johnson | first1 = Bankole A. | title = Addiction medicine: science and practice | url = {{google books |plainurl=y |id=zvbr4Zn9S9MC|page=342}} | year = 2011 | publisher = Springer | location = New York | isbn = 978-1-4419-0337-2 | pages = 301–03 | url-status = live | archive-url = https://web.archive.org/web/20151201092622/https://books.google.com/books?id=zvbr4Zn9S9MC&pg=PA342 | archive-date = 1 December 2015 }}</ref>
-A [[Kindling (sedative-hypnotic withdrawal)|kindling effect]] also occurs in people with alcohol use disorders whereby each subsequent withdrawal syndrome is more severe than the previous withdrawal episode; this is due to neuroadaptations which occur as a result of periods of abstinence followed by re-exposure to alcohol. Individuals who have had multiple withdrawal episodes are more likely to develop seizures and experience more severe anxiety during withdrawal from alcohol than alcohol-dependent individuals without a history of past alcohol withdrawal episodes. The kindling effect leads to persistent functional changes in brain neural circuits as well as to [[gene expression]].<ref name="Breese-2011">{{cite journal | vauthors = Breese GR, Sinha R, Heilig M | title = Chronic alcohol neuroadaptation and stress contribute to susceptibility for alcohol craving and relapse | journal = Pharmacology & Therapeutics | volume = 129 | issue = 2 | pages = 149–71 | date = February 2011 | pmid = 20951730 | pmc = 3026093 | doi = 10.1016/j.pharmthera.2010.09.007 }}</ref> Kindling also results in the intensification of psychological symptoms of alcohol withdrawal.<ref name="pmid20148778" /> There are decision tools and questionnaires that help guide physicians in evaluating alcohol withdrawal. For example, the CIWA-Ar objectifies alcohol withdrawal symptoms in order to guide therapy decisions which allows for an efficient interview while at the same time retaining clinical usefulness, validity, and reliability, ensuring proper care for withdrawal patients, who can be in danger of death.<ref>{{cite journal | vauthors = Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM | title = Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar) | journal = British Journal of Addiction | volume = 84 | issue = 11 | pages = 1353–7 | date = November 1989 | pmid = 2597811 | doi = 10.1111/j.1360-0443.1989.tb00737.x | url = http://www.medicine.nevada.edu/residency/lasvegas/internalmed/documents/CIWA-ARBJA.pdf | access-date = 25 October 2017 | citeseerx = 10.1.1.489.341 | df = dmy-all | archive-url = https://web.archive.org/web/20130810022242/http://www.medicine.nevada.edu/residency/lasvegas/internalmed/documents/ciwa-arbja.pdf | archive-date = 10 August 2013 }}</ref>
+A [[Kindling (sedative-hypnotic withdrawal)|kindling effect]] also occurs in people with alcohol use disorders whereby each subsequent withdrawal syndrome is more severe than the previous withdrawal episode; this is due to neuroadaptations which occur as a result of periods of abstinence followed by re-exposure to alcohol. Individuals who have had multiple withdrawal episodes are more likely to develop seizures and experience more severe anxiety during withdrawal from alcohol than alcohol-dependent individuals without a history of past alcohol withdrawal episodes. The kindling effect leads to persistent functional changes in brain neural circuits as well as to [[gene expression]].<ref name="Breese-2011">{{cite journal | vauthors = Breese GR, Sinha R, Heilig M | title = Chronic alcohol neuroadaptation and stress contribute to susceptibility for alcohol craving and relapse | journal = Pharmacology & Therapeutics | volume = 129 | issue = 2 | pages = 149–71 | date = February 2011 | pmid = 20951730 | pmc = 3026093 | doi = 10.1016/j.pharmthera.2010.09.007 }}</ref> Kindling also results in the intensification of psychological symptoms of alcohol withdrawal.<ref name="pmid20148778" /> There are decision tools and questionnaires that help guide physicians in evaluating alcohol withdrawal. For example, the CIWA-Ar objectifies alcohol withdrawal symptoms in order to guide therapy decisions which allows for an efficient interview while at the same time retaining clinical usefulness, validity, and reliability, ensuring proper care for withdrawal patients, who can be in danger of death.<ref>{{cite journal | vauthors = Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM | title = Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar) | journal = British Journal of Addiction | volume = 84 | issue = 11 | pages = 1353–7 | date = November 1989 | pmid = 2597811 | doi = 10.1111/j.1360-0443.1989.tb00737.x | url = http://www.medicine.nevada.edu/residency/lasvegas/internalmed/documents/CIWA-ARBJA.pdf | access-date = 25 October 2017 | citeseerx = 10.1.1.489.341 | archive-url = https://web.archive.org/web/20130810022242/http://www.medicine.nevada.edu/residency/lasvegas/internalmed/documents/ciwa-arbja.pdf | archive-date = 10 August 2013 }}</ref>
 ==Causes==
 [[File:Mental health as a risk factor for alcohol dependency or abuse, OWID.svg|thumb|upright=2|Mental health as a risk factor for alcohol dependence or abuse]]
 [[File:William Hogarth - Gin Lane.jpg|thumb|[[William Hogarth|William Hogarth's]] ''[[Gin Lane]]'', 1751]]
-A complex combination of genetic and environmental factors influences the risk of the development of alcoholism.<ref name="Enoch-2006">{{cite journal | vauthors = Enoch MA | title = Genetic and environmental influences on the development of alcoholism: resilience vs. risk | journal = Annals of the New York Academy of Sciences | volume = 1094 | issue = 1 | pages = 193–201 | date = December 2006 | pmid = 17347351 | doi = 10.1196/annals.1376.019 | url = https://zenodo.org/record/1235882 | bibcode = 2006NYASA1094..193E | s2cid = 248697 }}</ref> Genes that influence the metabolism of alcohol also influence the risk of alcoholism, as can a family history of alcoholism.<ref name="Edenberg 2281–2297">{{cite journal | vauthors = Edenberg HJ, McClintick JN | title = Alcohol Dehydrogenases, Aldehyde Dehydrogenases, and Alcohol Use Disorders: A Critical Review | journal = Alcoholism: Clinical and Experimental Research | volume = 42 | issue = 12 | pages = 2281–2297 | date = December 2018 | pmid = 30320893 | pmc = 6286250 | doi = 10.1111/acer.13904 }}</ref> There is compelling evidence that alcohol use at an early age may influence the [[gene expression|expression of genes]] which increase the risk of alcohol dependence. These [[Molecular and epigenetic mechanisms of alcoholism|genetic and epigenetic results]] are regarded as consistent with large longitudinal population studies finding that the younger the age of drinking onset, the greater the prevalence of lifetime alcohol dependence.<ref>{{cite journal | vauthors = Agrawal A, Sartor CE, Lynskey MT, Grant JD, Pergadia ML, Grucza R, Bucholz KK, Nelson EC, Madden PA, Martin NG, Heath AC | title = Evidence for an interaction between age at first drink and genetic influences on DSM-IV alcohol dependence symptoms | journal = Alcoholism: Clinical and Experimental Research | volume = 33 | issue = 12 | pages = 2047–56 | date = December 2009 | pmid = 19764935 | pmc = 2883563 | doi = 10.1111/j.1530-0277.2009.01044.x }}</ref><ref name="pmid27677720">{{cite journal|vauthors=Crews FT, Vetreno RP, Broadwater MA, Robinson DL| title=Adolescent Alcohol Exposure Persistently Impacts Adult Neurobiology and Behavior. | journal=Pharmacol Rev | year= 2016 | volume= 68 | issue= 4 | pages= 1074–1109 | pmid=27677720 | doi=10.1124/pr.115.012138 | pmc=5050442 }}</ref>
+A complex combination of genetic and environmental factors influences the risk of the development of alcoholism.<ref name="Enoch-2006">{{cite journal | vauthors = Enoch MA | title = Genetic and environmental influences on the development of alcoholism: resilience vs. risk | journal = Annals of the New York Academy of Sciences | volume = 1094 | issue = 1 | pages = 193–201 | date = December 2006 | pmid = 17347351 | doi = 10.1196/annals.1376.019 | url = https://zenodo.org/record/1235882 | bibcode = 2006NYASA1094..193E | s2cid = 248697 | access-date = 1 July 2024 | archive-date = 25 July 2020 | archive-url = https://web.archive.org/web/20200725015737/https://zenodo.org/record/1235882 | url-status = live }}</ref> Genes that influence the metabolism of alcohol also influence the risk of alcoholism, as can a family history of alcoholism.<ref name="Edenberg 2281–2297">{{cite journal | vauthors = Edenberg HJ, McClintick JN | title = Alcohol Dehydrogenases, Aldehyde Dehydrogenases, and Alcohol Use Disorders: A Critical Review | journal = Alcoholism: Clinical and Experimental Research | volume = 42 | issue = 12 | pages = 2281–2297 | date = December 2018 | pmid = 30320893 | pmc = 6286250 | doi = 10.1111/acer.13904 }}</ref> There is compelling evidence that alcohol use at an early age may influence the [[gene expression|expression of genes]] which increase the risk of alcohol dependence. These [[Molecular and epigenetic mechanisms of alcoholism|genetic and epigenetic results]] are regarded as consistent with large longitudinal population studies finding that the younger the age of drinking onset, the greater the prevalence of lifetime alcohol dependence.<ref>{{cite journal | vauthors = Agrawal A, Sartor CE, Lynskey MT, Grant JD, Pergadia ML, Grucza R, Bucholz KK, Nelson EC, Madden PA, Martin NG, Heath AC | title = Evidence for an interaction between age at first drink and genetic influences on DSM-IV alcohol dependence symptoms | journal = Alcoholism: Clinical and Experimental Research | volume = 33 | issue = 12 | pages = 2047–56 | date = December 2009 | pmid = 19764935 | pmc = 2883563 | doi = 10.1111/j.1530-0277.2009.01044.x }}</ref><ref name="pmid27677720">{{cite journal|vauthors=Crews FT, Vetreno RP, Broadwater MA, Robinson DL| title=Adolescent Alcohol Exposure Persistently Impacts Adult Neurobiology and Behavior. | journal=Pharmacol Rev | year= 2016 | volume= 68 | issue= 4 | pages= 1074–1109 | pmid=27677720 | doi=10.1124/pr.115.012138 | pmc=5050442 }}</ref>
 [[Psychological trauma|Severe childhood trauma]] is also associated with a general increase in the risk of drug dependency.<ref name="Enoch-2006"/> Lack of peer and family support is associated with an increased risk of alcoholism developing.<ref name="Enoch-2006"/> Genetics and adolescence are associated with an increased sensitivity to the neurotoxic effects of chronic alcohol misuse. [[Cerebral cortex|Cortical]] degeneration due to the neurotoxic effects increases impulsive behaviour, which may contribute to the development, persistence and severity of alcohol use disorders. There is evidence that with abstinence, there is a reversal of at least some of the alcohol induced central nervous system damage.<ref name="Crews-2009">{{cite journal | vauthors = Crews FT, Boettiger CA | title = Impulsivity, frontal lobes and risk for addiction | journal = Pharmacology, Biochemistry, and Behavior | volume = 93 | issue = 3 | pages = 237–47 | date = September 2009 | pmid = 19410598 | pmc = 2730661 | doi = 10.1016/j.pbb.2009.04.018 }}</ref> The use of cannabis was associated with later problems with alcohol use.<ref name="PMID26875671">{{cite journal | vauthors = Weinberger AH, Platt J, Goodwin RD | title = Is cannabis use associated with an increased risk of onset and persistence of alcohol use disorders? A three-year prospective study among adults in the United States | journal = Drug and Alcohol Dependence | volume = 161 | pages = 363–7 | date = April 2016 | pmid = 26875671 | pmc = 5028105 | doi = 10.1016/j.drugalcdep.2016.01.014 }}</ref> Alcohol use was associated with an increased probability of later use of tobacco and illegal drugs such as cannabis.<ref name="PMID22712674">{{cite journal | vauthors = Kirby T, Barry AE | title = Alcohol as a gateway drug: a study of US 12th graders | journal = The Journal of School Health | volume = 82 | issue = 8 | pages = 371–9 | date = August 2012 | pmid = 22712674 | doi = 10.1111/j.1746-1561.2012.00712.x | url = http://www.mamacultiva.org/wp-content/uploads/2015/pdf/A8%20-%20Alcohol%20as%20a%20Gateway%20Drug%20A%20Study%20of%20US%2012th%20Graders.pdf | url-status = live | archive-url = https://web.archive.org/web/20160604012851/http://www.mamacultiva.org/wp-content/uploads/2015/pdf/A8%20-%20Alcohol%20as%20a%20Gateway%20Drug%20A%20Study%20of%20US%2012th%20Graders.pdf | archive-date = 4 June 2016 }}</ref>
 ===Availability===
-Alcohol is the most available, widely consumed, and widely misused [[recreational drug]]. [[Beer]] alone is the world's most widely consumed<ref>{{cite web|title=Volume of World Beer Production|website=European Beer Guide|url=http://www.europeanbeerguide.net/eustats.htm#production|access-date=17 October 2006| archive-url= https://web.archive.org/web/20061028165040/http://www.europeanbeerguide.net/eustats.htm| archive-date= 28 October 2006 | url-status= live}}</ref> [[alcoholic beverage]]; it is the third-most popular drink overall, after [[Drinking water|water]] and [[tea]].<ref name="Nelson 2005">{{cite book|url={{google books |plainurl=y |id=6xul0O_SI1MC|page=1}}|title=The Barbarian's Beverage: A History of Beer in Ancient Europe|year=2005|publisher=Routledge|location=Abingdon, Oxon|isbn=978-0-415-31121-2|page=1|access-date=21 September 2010|last= Nelson|first=Max }}</ref> It is thought by some to be the oldest [[fermented beverage]].<ref>{{cite book|title=The Alchemy of Culture: Intoxicants in Society|first=Richard|last=Rudgley |isbn=978-0-7141-1736-2|year=1993|pages=411|url={{google books |plainurl=y |id=5baAAAAAMAAJ}}|publisher=British Museum Press|location=London|access-date=13 January 2012}}</ref><ref>{{cite book|title=Origin and History of Beer and Brewing: From Prehistoric Times to the Beginning of Brewing Science and Technology|first=John P |last=Arnold |isbn=978-0-9662084-1-2|year=2005|page=411|url={{google books |plainurl=y |id=O5CPAAAACAAJ}} |publisher=BeerBooks |location=Cleveland, OH|access-date=13 January 2012}}</ref><ref>Joshua J. Mark (2011). "[https://www.worldhistory.org/Beer/ Beer]". Ancient History Encyclopedia. {{webarchive|url=https://web.archive.org/web/20140703005835/http://www.ancient.eu.com/Beer/ |date=3 July 2014 }}.</ref><ref>{{cite book|first1=Ben|last1= McFarland |url={{google books |plainurl=y |id=SHh-4M_QxEsC|page=10}}|title=World's Best Beers: One Thousand |publisher=Sterling Publishing Company, Inc.|isbn=978-1-4027-6694-7 |year=2009 }}</ref>
+Alcohol is the most available, widely consumed, and widely misused [[recreational drug]]. [[Beer]] alone is the world's most widely consumed<ref>{{cite web|title=Volume of World Beer Production|website=European Beer Guide|url=http://www.europeanbeerguide.net/eustats.htm#production|access-date=17 October 2006| archive-url= https://web.archive.org/web/20061028165040/http://www.europeanbeerguide.net/eustats.htm| archive-date= 28 October 2006 | url-status= live}}</ref> [[alcoholic beverage]]; it is the third-most popular drink overall, after [[Drinking water|water]] and [[tea]].<ref name="Nelson 2005">{{cite book|url=https://books.google.com/books?id=6xul0O_SI1MC&pg=PA1|title=The Barbarian's Beverage: A History of Beer in Ancient Europe|year=2005|publisher=Routledge|location=Abingdon, Oxon|isbn=978-0-415-31121-2|page=1|access-date=21 September 2010|last=Nelson|first=Max|archive-date=14 January 2023|archive-url=https://web.archive.org/web/20230114105316/https://books.google.com/books?id=6xul0O_SI1MC&pg=PA1|url-status=live}}</ref> It is thought by some to be the oldest [[fermented beverage]].<ref>{{cite book|title=The Alchemy of Culture: Intoxicants in Society|first=Richard|last=Rudgley |isbn=978-0-7141-1736-2|year=1993|pages=411|url={{google books |plainurl=y |id=5baAAAAAMAAJ}}|publisher=British Museum Press|location=London|access-date=13 January 2012}}</ref><ref>{{cite book|title=Origin and History of Beer and Brewing: From Prehistoric Times to the Beginning of Brewing Science and Technology|first=John P |last=Arnold |isbn=978-0-9662084-1-2|year=2005|page=411|url={{google books |plainurl=y |id=O5CPAAAACAAJ}} |publisher=BeerBooks |location=Cleveland, OH|access-date=13 January 2012}}</ref><ref>Joshua J. Mark (2011). "[https://www.worldhistory.org/Beer/ Beer]". Ancient History Encyclopedia. {{webarchive|url=https://web.archive.org/web/20140703005835/http://www.ancient.eu.com/Beer/ |date=3 July 2014 }}.</ref><ref>{{cite book|first1=Ben|last1= McFarland |url={{google books |plainurl=y |id=SHh-4M_QxEsC|page=10}}|title=World's Best Beers: One Thousand |publisher=Sterling Publishing Company, Inc.|isbn=978-1-4027-6694-7 |year=2009 }}</ref>
 ===Gender difference===
@@ Line 127: / Line 127: @@
 ===Definition===
 [[File:Emil Mayer 024.jpg|thumb|A man drinking from a bottle of liquor while sitting on a boardwalk, {{circa|1905}}–1914. Picture by Austrian photographer [[Emil Mayer]].]]
-Because there is disagreement on the definition of the word alcoholism, it is not a recognized diagnosis, and the use of the term alcoholism is discouraged due to its heavily [[Social stigma|stigmatized]] connotations.<ref name=morrismoss2022 /><ref name="ashfordbrown2018" /> It is classified as alcohol use disorder<ref name="NIH2013" /> in the [[DSM-5]]<ref name="DSM5" /> or [[alcohol dependence]] in the [[ICD-11]].<ref>{{cite web|date=September 2020|title=6C40.2 Alcohol dependence|url=https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1580466198|access-date=6 December 2020|website=ICD-11 for Mortality and Morbidity Statistics}}</ref> In 1979, the World Health Organization discouraged the use of ''alcoholism'' due to its inexact meaning, preferring ''alcohol dependence syndrome''.<ref name="ladtpwho">{{cite web |url=https://www.who.int/substance_abuse/terminology/who_lexicon/en/ |title=Lexicon of alcohol and drug terms published by the World Health Organization |author=WHO |publisher=World Health Organization |archive-url=https://web.archive.org/web/20130205230313/http://www.who.int/substance_abuse/terminology/who_lexicon/en/ |archive-date=5 February 2013 }}</ref>
+Because there is disagreement on the definition of the word alcoholism, it is not a recognized diagnosis, and the use of the term alcoholism is discouraged due to its heavily [[Social stigma|stigmatized]] connotations.<ref name=morrismoss2022 /><ref name="ashfordbrown2018" /> It is classified as alcohol use disorder<ref name="NIH2013" /> in the [[DSM-5]]<ref name="DSM5" /> or [[alcohol dependence]] in the [[ICD-11]].<ref>{{cite web|date=September 2020|title=6C40.2 Alcohol dependence|url=https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1580466198|access-date=6 December 2020|website=ICD-11 for Mortality and Morbidity Statistics|archive-date=1 August 2018|archive-url=https://archive.today/20180801205234/https://icd.who.int/browse11/l-m/en%23/http://id.who.int/icd/entity/294762853#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1580466198|url-status=live}}</ref> In 1979, the World Health Organization discouraged the use of ''alcoholism'' due to its inexact meaning, preferring ''alcohol dependence syndrome''.<ref name="ladtpwho">{{cite web |url=https://www.who.int/substance_abuse/terminology/who_lexicon/en/ |title=Lexicon of alcohol and drug terms published by the World Health Organization |publisher=World Health Organization |archive-url=https://web.archive.org/web/20130205230313/http://www.who.int/substance_abuse/terminology/who_lexicon/en/ |archive-date=5 February 2013 }}</ref>
 Misuse, problem use, abuse, and heavy use of alcohol refer to improper use of alcohol, which may cause physical, social, or moral harm to the drinker.<ref name="the_american_heritage_dictionary_of_the_english_language_a12">{{cite book| author= American Heritage Dictionaries | title = The American Heritage dictionary of the English language | url = {{google books |plainurl=y |id=uPCFIQAACAAJ}} | year=2006 |publisher = Houghton Mifflin | location = Boston | edition = 4 |quote = To use wrongly or improperly; misuse: abuse alcohol | isbn = 978-0-618-70172-8 }}</ref> ''The Dietary Guidelines for Americans'', issued by the [[United States Department of Agriculture]] (USDA) in 2005, defines "moderate use" as no more than two alcoholic beverages a day for men and no more than one alcoholic beverage a day for women.<ref>{{cite web |url=http://www.health.gov/DIETARYGUIDELINES/dga2005/document/html/chapter9.htm |title=Dietary Guidelines for Americans 2005 |year=2005 |publisher=health.gov |archive-url=https://web.archive.org/web/20070701174135/http://www.health.gov/DIETARYGUIDELINES/dga2005/document/html/chapter9.htm |archive-date=1 July 2007 |access-date=28 November 2009 }} Dietary Guidelines</ref> The [[National Institute on Alcohol Abuse and Alcoholism]] (NIAAA) defines [[binge drinking]] as the amount of alcohol leading to a blood alcohol content (BAC) of 0.08, which, for most adults, would be reached by consuming five drinks for men or four for women over a two-hour period. According to the NIAAA, men may be at risk for alcohol-related problems if their alcohol consumption exceeds 14 [[standard drink]]s per week or 4 drinks per day, and women may be at risk if they have more than 7 standard drinks per week or 3 drinks per day. It defines a standard drink as one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5&nbsp;ounces of distilled spirits.<ref>{{cite journal |date=April 2006 |title=Young Adult Drinking |url=http://pubs.niaaa.nih.gov/publications/aa68/aa68.htm |url-status=live |journal=Alcohol Alert |archive-url=https://web.archive.org/web/20130213205702/http://pubs.niaaa.nih.gov/publications/aa68/aa68.htm |archive-date=13 February 2013 |access-date=18 February 2013 |number=68}}</ref> Despite this risk, a 2014 report in the National Survey on Drug Use and Health found that only 10% of either "heavy drinkers" or "binge drinkers" defined according to the above criteria also met the criteria for alcohol dependence, while only 1.3% of non-binge drinkers met the criteria. An inference drawn from this study is that evidence-based policy strategies and clinical preventive services may effectively reduce binge drinking without requiring addiction treatment in most cases.<ref name="Esser2014">{{cite journal | vauthors = Esser MB, Hedden SL, Kanny D, Brewer RD, Gfroerer JC, Naimi TS | title = Prevalence of alcohol dependence among US adult drinkers, 2009–2011 | journal = Preventing Chronic Disease | volume = 11 | pages = E206 | date = November 2014 | pmid = 25412029 | pmc = 4241371 | doi = 10.5888/pcd11.140329 }}</ref>
@@ Line 140: / Line 140: @@
 # Seeking the mood swing. People will drink to regain that happy feeling in phase 1; the drinking will increase as more alcohol is required to achieve the same effect. Again at this stage, there are no significant consequences.
 # At the third stage there are physical and social consequences such as hangovers, family problems, and work problems. People will continue to drink excessively, disregarding the problems.
-# The fourth stage can be detrimental with a risk for premature death. People in this phase now drink to feel normal, they block out the feelings of overwhelming guilt, remorse, anxiety, and shame they experience when sober.<ref name=Thomb1999/>
+# The fourth stage can be detrimental with a risk for premature death. People in this phase now drink to feel normal and block out the feelings of overwhelming guilt, remorse, anxiety, and shame they experience when sober.<ref name=Thomb1999/>
 ====DSM and ICD====
@@ Line 168: / Line 168: @@
 | Episode of harmful use of alcohol, Harmful pattern of use of alcohol, or Alcohol dependence
 |
-* ''Episode of harmful use of alcohol'' – "A single episode of use of alcohol that has caused damage to a person's physical or mental health or has resulted in behaviour leading to harm to the health of others ..."<ref>{{cite web |date=April 2019|title=6C40.0 Episode of harmful use of alcohol|url=https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f766814084|access-date=16 August 2020|website=ICD-11 for Mortality and Morbidity Statistics|publisher=World Health Organization}}</ref>
+* ''Episode of harmful use of alcohol'' – "A single episode of use of alcohol that has caused damage to a person's physical or mental health or has resulted in behaviour leading to harm to the health of others ..."<ref>{{cite web|date=April 2019|title=6C40.0 Episode of harmful use of alcohol|url=https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f766814084|access-date=16 August 2020|website=ICD-11 for Mortality and Morbidity Statistics|publisher=World Health Organization|archive-date=1 August 2018|archive-url=https://archive.today/20180801205234/https://icd.who.int/browse11/l-m/en%23/http://id.who.int/icd/entity/294762853#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f766814084|url-status=live}}</ref>
-* ''Harmful pattern of use of alcohol'' – "A pattern of alcohol use that has caused damage to a person's physical or mental health or has resulted in behaviour leading to harm to the health of others ..."<ref>{{cite web |date=April 2019|title=6C40.1 Harmful pattern of use of alcohol|url=https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f714690795|access-date=16 August 2020|website=ICD-11 for Mortality and Morbidity Statistics|publisher=World Health Organization}}</ref>
+* ''Harmful pattern of use of alcohol'' – "A pattern of alcohol use that has caused damage to a person's physical or mental health or has resulted in behaviour leading to harm to the health of others ..."<ref>{{cite web|date=April 2019|title=6C40.1 Harmful pattern of use of alcohol|url=https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f714690795|access-date=16 August 2020|website=ICD-11 for Mortality and Morbidity Statistics|publisher=World Health Organization|archive-date=1 August 2018|archive-url=https://archive.today/20180801205234/https://icd.who.int/browse11/l-m/en%23/http://id.who.int/icd/entity/294762853#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f714690795|url-status=live}}</ref>
-* ''Alcohol dependence'' – "Alcohol dependence is a disorder of regulation of alcohol use arising from repeated or continuous use of alcohol. The characteristic feature is a strong internal drive to use alcohol. ... The features of dependence are usually evident over a period of at least 12 months but the diagnosis may be made if alcohol use is continuous (daily or almost daily) for at least 1 month."<ref>{{cite web |date=April 2019|title=6C40.2 Alcohol dependence|url=https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1580466198|access-date=16 August 2020|website=ICD-11 for Mortality and Morbidity Statistics|publisher=World Health Organization}}</ref>
+* ''Alcohol dependence'' – "Alcohol dependence is a disorder of regulation of alcohol use arising from repeated or continuous use of alcohol. The characteristic feature is a strong internal drive to use alcohol. ... The features of dependence are usually evident over a period of at least 12 months but the diagnosis may be made if alcohol use is continuous (daily or almost daily) for at least 1 month."<ref>{{cite web|date=April 2019|title=6C40.2 Alcohol dependence|url=https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1580466198|access-date=16 August 2020|website=ICD-11 for Mortality and Morbidity Statistics|publisher=World Health Organization|archive-date=1 August 2018|archive-url=https://archive.today/20180801205234/https://icd.who.int/browse11/l-m/en%23/http://id.who.int/icd/entity/294762853#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1580466198|url-status=live}}</ref>
 |-
 |}
@@ Line 191: / Line 191: @@
 # Have you ever felt you needed a drink first thing in the morning (eye-opener) to steady your nerves or to get rid of a hangover?<ref>{{cite journal | vauthors = Ewing JA | title = Detecting alcoholism. The CAGE questionnaire | journal = JAMA | volume = 252 | issue = 14 | pages = 1905–7 | date = October 1984 | pmid = 6471323 | doi = 10.1001/jama.1984.03350140051025 }}</ref><ref>{{cite web|url=http://www.whoguidemhpcuk.org/downloads/primary_care/11-1_CAGE_questionnaire.pdf |title=CAGE questionnaire – screen for alcohol misuse |archive-url=https://web.archive.org/web/20110728175054/http://www.whoguidemhpcuk.org/downloads/primary_care/11-1_CAGE_questionnaire.pdf |archive-date=28 July 2011 }}</ref>}}
-:The CAGE questionnaire has demonstrated a high effectiveness in detecting alcohol-related problems; however, it has limitations in people with less severe alcohol-related problems, white women and college students.<ref>{{cite journal | vauthors = Dhalla S, Kopec JA | title = The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies | journal = Clinical and Investigative Medicine | volume = 30 | issue = 1 | pages = 33–41 | year = 2007 | pmid = 17716538 | doi = 10.25011/cim.v30i1.447 | df = dmy-all | doi-access = free }}</ref>
+:The CAGE questionnaire has demonstrated a high effectiveness in detecting alcohol-related problems; however, it has limitations in people with less severe alcohol-related problems, white women and college students.<ref>{{cite journal | vauthors = Dhalla S, Kopec JA | title = The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies | journal = Clinical and Investigative Medicine | volume = 30 | issue = 1 | pages = 33–41 | year = 2007 | pmid = 17716538 | doi = 10.25011/cim.v30i1.447 | doi-access = free }}</ref>
 Other tests are sometimes used for the detection of alcohol dependence, such as the [[Alcohol Dependence Data Questionnaire]], which is a more sensitive diagnostic test than the [[CAGE questionnaire]]. It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol use.<ref>{{cite web |url=http://www.emcdda.europa.eu/html.cfm/index3556EN.html |title=Alcohol Dependence Data Questionnaire (SADD) | vauthors = Raistrick D, Dunbar G, Davidson R |year=1983 |publisher=European Monitoring Centre for Drugs and Drug Addiction |url-status=live |archive-url=https://web.archive.org/web/20160721101929/http://www.emcdda.europa.eu/html.cfm/index3556EN.html |archive-date=21 July 2016 }}</ref> The [[Michigan Alcohol Screening Test]] (MAST) is a screening tool for alcoholism widely used by courts to determine the appropriate sentencing for people convicted of alcohol-related offenses,<ref>{{cite web |url=http://www.ncadd-sfv.org/symptoms/mast_test.html |title=Michigan Alcohol Screening Test |publisher=The National Council on Alcoholism and Drug Dependence |archive-url=https://web.archive.org/web/20060906123532/http://www.ncadd-sfv.org/symptoms/mast_test.html |archive-date=6 September 2006 }}</ref> [[driving under the influence]] being the most common. The [[Alcohol Use Disorders Identification Test]] (AUDIT), a screening questionnaire developed by the [[World Health Organization]], is unique in that it has been validated in six countries and is used internationally. Like the CAGE questionnaire, it uses a simple set of questions – a high score earning a deeper investigation.<ref>{{cite web |url=http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf |title=The Alcohol Use Disorders Identification Test; Guidelines for Use in Primary Care |first1=Thomas F. |last1=Babor |first2=John C. |last2=Higgins-Biddle |first3=John B. |last3=Saunders |first4=Maristela G. |last4=Monteiro |year=2001 |publisher=World Health Organization |archive-url=https://web.archive.org/web/20060502132711/http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf |archive-date=2 May 2006 }}</ref> The [[Paddington Alcohol Test]] (PAT) was designed to screen for alcohol-related problems amongst those attending [[Accident and Emergency department]]s. It concords well with the AUDIT questionnaire but is administered in a fifth of the time.<ref>{{cite journal | vauthors = Smith SG, Touquet R, Wright S, Das Gupta N | title = Detection of alcohol misusing patients in accident and emergency departments: the Paddington alcohol test (PAT) | journal = Journal of Accident & Emergency Medicine | volume = 13 | issue = 5 | pages = 308–12 | date = September 1996 | pmid = 8894853 | pmc = 1342761 | doi = 10.1136/emj.13.5.308 }}</ref>
 ===Urine and blood tests===
-There are reliable tests for the actual use of alcohol, one common test being that of [[blood alcohol content]] (BAC).<ref>{{cite journal | vauthors = Jones AW | s2cid = 11117640 | title = Urine as a biological specimen for forensic analysis of alcohol and variability in the urine-to-blood relationship | journal = Toxicological Reviews | volume = 25 | issue = 1 | pages = 15–35 | year = 2006 | pmid = 16856767 | doi = 10.2165/00139709-200625010-00002 }}</ref> These tests do not differentiate people with alcohol use disorders from people without; however, long-term heavy drinking does have a few recognizable effects on the body, including:<ref>{{cite journal | vauthors = Das SK, Dhanya L, Vasudevan DM | s2cid = 83600284 | title = Biomarkers of alcoholism: an updated review | journal = Scandinavian Journal of Clinical and Laboratory Investigation | volume = 68 | issue = 2 | pages = 81–92 | year = 2008 | pmid = 17852805 | doi = 10.1080/00365510701532662 }}</ref>
+There are reliable tests for the actual use of alcohol, one common test being that of [[blood alcohol content]] (BAC).<ref>{{cite journal | vauthors = Jones AW | s2cid = 11117640 | title = Urine as a biological specimen for forensic analysis of alcohol and variability in the urine-to-blood relationship | journal = Toxicological Reviews | volume = 25 | issue = 1 | pages = 15–35 | year = 2006 | pmid = 16856767 | doi = 10.2165/00139709-200625010-00002 }}</ref> These tests do not differentiate people with alcohol use disorders from people without; however, long-term heavy drinking does have a few recognizable effects on the body, including:{{citation needed|date=October 2024}}
 * [[Macrocytosis]] (enlarged [[Mean corpuscular volume|MCV]])
 * Elevated [[Gamma glutamyl transpeptidase|GGT]]
@@ Line 208: / Line 208: @@
 ==Prevention==
 {{further|Alcohol education}}
-The [[World Health Organization]], the [[European Union]] and other regional bodies, national governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism.<ref name="alchwho2010">{{cite web |url=https://www.who.int/topics/alcohol_drinking/en/ |title=Alcohol |author=World Health Organization |year=2010 |url-status=live |archive-url=https://web.archive.org/web/20100226094205/http://www.who.int/topics/alcohol_drinking/en/ |archive-date=26 February 2010 }}</ref><ref name="apitwhoer">{{cite web|url=http://www.euro.who.int/document/mediacentre/fs1005e.pdf |title=Alcohol policy in the WHO European Region: current status and the way forward |date=12 September 2005 |publisher=World Health Organization |archive-url=https://web.archive.org/web/20100123105252/http://www.euro.who.int/document/mediacentre/fs1005e.pdf |archive-date=23 January 2010 }}</ref>
+The [[World Health Organization]], the [[European Union]] and other regional bodies, national governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism.<ref name="alchwho2010">{{cite web |url=https://www.who.int/topics/alcohol_drinking/en/ |title=Alcohol |publisher=World Health Organization |year=2010 |url-status=live |archive-url=https://web.archive.org/web/20100226094205/http://www.who.int/topics/alcohol_drinking/en/ |archive-date=26 February 2010 }}</ref><ref name="apitwhoer">{{cite web|url=http://www.euro.who.int/document/mediacentre/fs1005e.pdf |title=Alcohol policy in the WHO European Region: current status and the way forward |date=12 September 2005 |publisher=World Health Organization |archive-url=https://web.archive.org/web/20100123105252/http://www.euro.who.int/document/mediacentre/fs1005e.pdf |archive-date=23 January 2010 }}</ref>
 Increasing the age at which alcohol can be purchased, and banning or restricting alcohol beverage advertising are common methods to reduce alcohol use among adolescents and young adults in particular. Another common method of alcoholism prevention is taxation of alcohol products – increasing price of alcohol by 10% is linked with reduction of consumption of up to 10%.<ref name=Elder2009>{{cite journal | vauthors = Elder R, Lawrence B, Ferguson A, Naimi T, Brewer R, Chattopadhyay S, Toomey T, Fielding J | title = The Effectiveness of Tax Policy Interventions for Reducing Excessive Alcohol Consumption and Related Harms | journal = American Journal of Preventive Medicine | volume = 38 | issue = 2 |year = 2010 | pages = 217–229 | issn = 0749-3797 | doi = 10.1016/j.amepre.2009.11.005| pmid = 20117579 | pmc = 3735171 }}</ref>
@@ Line 226: / Line 226: @@
 [[File:Alcoholics Anonymous Regional Service Center by David Shankbone.jpg|thumb|A regional service center for [[Alcoholics Anonymous]]]]
-Various forms of [[group therapy]] or [[psychotherapy]] are sometimes used to encourage and support abstinence from alcohol, or to reduce alcohol consumption to levels that are not associated with adverse outcomes. Mutual-aid group-counseling is an approach used to facilitate relapse prevention.<ref name="Morgan-Lopez-2006"/> [[Alcoholics Anonymous]] was one of the earliest organizations formed to provide mutual [[peer support]] and non-professional counseling, however [[Effectiveness of Alcoholics Anonymous|the effectiveness of Alcoholics Anonymous]] is disputed.<ref name="Cochrane2006">{{cite journal |last1=Ferri |first1=Marcia |last2=Amato |first2=Laura |last3=Davoli |first3=Marina |title=Alcoholics Anonymous and other twelve-step programmes for alcohol dependence |journal=Cochrane Database of Systematic Reviews |issue=3 |pages=CD005032 |date=19 July 2006 |pmid=16856072 |doi=10.1002/14651858.CD005032.pub2|quote=no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems}}</ref> A 2020 [[Cochrane Library#The Cochrane Database of Systematic Reviews|Cochrane review]] concluded that Twelve-Step Facilitation (TSF) probably achieves outcomes such as fewer drinks per drinking day, however evidence for such a conclusion comes from low to moderate certainty evidence "so should be regarded with caution".<ref name="Cochrane2020_p35">Kelly, John F.; Humphreys, Keith; Ferri, Marica (2020). "Alcoholics Anonymous and other 12-step programs for alcohol use disorder". Cochrane Database of Systematic Reviews. 3 (CD012880): 35. doi:10.1002/14651858.CD012880.pub2. PMC 7065341. PMID 32159228.</ref> Others include [[LifeRing Secular Recovery]], [[SMART Recovery]], [[Women for Sobriety]], and [[Secular Organizations for Sobriety]].<ref>{{cite web|url=http://www.helpguide.org/articles/addiction/self-help-groups-for-alcohol-addiction.htm|title=Self-Help Groups for Alcohol Addiction| vauthors = Smith M, Saisan J |year=2016|url-status=live|archive-url=https://web.archive.org/web/20150521163926/http://www.helpguide.org/articles/addiction/self-help-groups-for-alcohol-addiction.htm|archive-date=21 May 2015}}</ref>
+Various forms of [[group therapy]] or [[psychotherapy]] are sometimes used to encourage and support abstinence from alcohol, or to reduce alcohol consumption to levels that are not associated with adverse outcomes. Mutual-aid group-counseling is an approach used to facilitate relapse prevention.<ref name="Morgan-Lopez-2006"/> [[Alcoholics Anonymous]] was one of the earliest organizations formed to provide mutual [[peer support]] and non-professional counseling, however [[Effectiveness of Alcoholics Anonymous|the effectiveness of Alcoholics Anonymous]] is disputed.<ref name="Cochrane2006">{{cite journal |last1=Ferri |first1=Marcia |last2=Amato |first2=Laura |last3=Davoli |first3=Marina |title=Alcoholics Anonymous and other twelve-step programmes for alcohol dependence |journal=Cochrane Database of Systematic Reviews |issue=3 |pages=CD005032 |date=19 July 2006 |pmid=16856072 |doi=10.1002/14651858.CD005032.pub2|quote=no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems}}</ref> A 2020 [[Cochrane Library#The Cochrane Database of Systematic Reviews|Cochrane review]] concluded that Twelve-Step Facilitation (TSF) probably achieves outcomes such as fewer drinks per drinking day, however evidence for such a conclusion comes from low to moderate certainty evidence "so should be regarded with caution".<ref name="Cochrane2020_p35">{{Cite journal |last1=Kelly |first1=John F |last2=Humphreys |first2=Keith |last3=Ferri |first3=Marica |date=2020-03-11 |editor-last=Cochrane Drugs and Alcohol Group |title=Alcoholics Anonymous and other 12-step programs for alcohol use disorder |journal=The Cochrane Database of Systematic Reviews|volume=2020 |issue=3 |pages=CD012880 |doi=10.1002/14651858.CD012880.pub2 |issn=1469-493X |pmc=7065341 |pmid=32159228}}</ref> Others include [[LifeRing Secular Recovery]], [[SMART Recovery]], [[Women for Sobriety]], and [[Secular Organizations for Sobriety]].<ref>{{cite web|url=http://www.helpguide.org/articles/addiction/self-help-groups-for-alcohol-addiction.htm|title=Self-Help Groups for Alcohol Addiction| vauthors = Smith M, Saisan J |year=2016|url-status=live|archive-url=https://web.archive.org/web/20150521163926/http://www.helpguide.org/articles/addiction/self-help-groups-for-alcohol-addiction.htm|archive-date=21 May 2015}}</ref>
-Manualized<ref>{{cite web|title=APA Dictionary of Psychology|url=https://dictionary.apa.org/|access-date=26 January 2022|website=dictionary.apa.org|language=en|quote=manualized therapy – interventions that are performed according to specific guidelines for administration, maximizing the probability of therapy being conducted consistently across settings, therapists, and clients. Also called manual-assisted therapy; manual-based therapy.}}</ref> Twelve Step Facilitation (TSF) interventions (i.e. therapy which encourages active, long-term Alcoholics Anonymous participation) for Alcohol Use Disorder lead to higher abstinence rates, compared to other clinical interventions and to wait-list control groups.<ref name=coch2020>{{cite journal | vauthors = Kelly JF, Humphreys K, Ferri M | title = Alcoholics Anonymous and other 12-step programs for alcohol use disorder | journal = The Cochrane Database of Systematic Reviews | volume = 3 | pages = CD012880 | date = March 2020 | issue = 3 | pmid = 32159228 | pmc = 7065341 | doi = 10.1002/14651858.CD012880.pub2 | type = Systematic review }}</ref>
+Manualized<ref>{{cite web|title=APA Dictionary of Psychology|url=https://dictionary.apa.org/|access-date=26 January 2022|website=dictionary.apa.org|quote=manualized therapy – interventions that are performed according to specific guidelines for administration, maximizing the probability of therapy being conducted consistently across settings, therapists, and clients. Also called manual-assisted therapy; manual-based therapy.|archive-date=27 April 2018|archive-url=https://web.archive.org/web/20180427011428/https://dictionary.apa.org/|url-status=live}}</ref> Twelve Step Facilitation (TSF) interventions (i.e. therapy which encourages active, long-term Alcoholics Anonymous participation) for Alcohol Use Disorder lead to higher abstinence rates, compared to other clinical interventions and to wait-list control groups.<ref name=coch2020>{{cite journal | vauthors = Kelly JF, Humphreys K, Ferri M | title = Alcoholics Anonymous and other 12-step programs for alcohol use disorder | journal = The Cochrane Database of Systematic Reviews | volume = 3 | pages = CD012880 | date = March 2020 | issue = 3 | pmid = 32159228 | pmc = 7065341 | doi = 10.1002/14651858.CD012880.pub2 | type = Systematic review }}</ref>
 ===Moderate drinking===
-Moderate drinking amongst people with alcohol dependence—often termed 'controlled drinking'—has been subject to significant controversy.<ref>{{cite web |last1=Ashton |first1=Mike |last2=Davies |first2=Natalie |title='Dangerous data': drinking after dependence |url=https://findings.org.uk/PHP/dl.php?file=cont_drink.hot |website=findings.org.uk |access-date=3 March 2023 |language=en}}</ref> Indeed, much of the skepticism toward the viability of moderate drinking goals stems from historical ideas about 'alcoholism', now replaced with 'alcohol use disorder' or [[alcohol dependence]] in most scientific contexts. A 2021 meta-analysis and systematic review of controlled drinking covering 22 studies concluded controlled drinking was a 'non-inferior' outcome to abstinence for many drinkers.<ref>{{cite journal |last1=Henssler |first1=Jonathan |last2=Müller |first2=Martin |last3=Carreira |first3=Helena |last4=Bschor |first4=Tom |last5=Heinz |first5=Andreas |last6=Baethge |first6=Christopher |title=Controlled drinking—non-abstinent versus abstinent treatment goals in alcohol use disorder: a systematic review, meta-analysis and meta-regression |journal=Addiction |date=August 2021 |volume=116 |issue=8 |pages=1973–1987 |doi=10.1111/add.15329 |pmid=33188563 |s2cid=226948754 |language=en |issn=0965-2140|doi-access=free }}</ref>
+Moderate drinking amongst people with alcohol dependence—often termed 'controlled drinking'—has been subject to significant controversy.<ref>{{cite web |last1=Ashton |first1=Mike |last2=Davies |first2=Natalie |title='Dangerous data': drinking after dependence |url=https://findings.org.uk/PHP/dl.php?file=cont_drink.hot |website=findings.org.uk |access-date=3 March 2023|archive-date=6 October 2022 |archive-url=https://web.archive.org/web/20221006213255/https://findings.org.uk/PHP/dl.php?file=cont_drink.hot |url-status=live }}</ref> Indeed, much of the skepticism toward the viability of moderate drinking goals stems from historical ideas about 'alcoholism', now replaced with 'alcohol use disorder' or [[alcohol dependence]] in most scientific contexts. A 2021 meta-analysis and systematic review of controlled drinking covering 22 studies concluded controlled drinking was a 'non-inferior' outcome to abstinence for many drinkers.<ref>{{cite journal |last1=Henssler |first1=Jonathan |last2=Müller |first2=Martin |last3=Carreira |first3=Helena |last4=Bschor |first4=Tom |last5=Heinz |first5=Andreas |last6=Baethge |first6=Christopher |title=Controlled drinking—non-abstinent versus abstinent treatment goals in alcohol use disorder: a systematic review, meta-analysis and meta-regression |journal=Addiction |date=August 2021 |volume=116 |issue=8 |pages=1973–1987 |doi=10.1111/add.15329 |pmid=33188563 |s2cid=226948754|issn=0965-2140|doi-access=free }}</ref>
-Rationing and moderation programs such as [[Moderation Management]] and DrinkWise do not mandate complete abstinence. While most people with alcohol use disorders are unable to limit their drinking in this way, some return to moderate drinking. A 2002 US study by the [[National Institute on Alcohol Abuse and Alcoholism]] (NIAAA) showed that 17.7% of individuals diagnosed as alcohol dependent more than one year prior returned to low-risk drinking. This group, however, showed fewer initial symptoms of dependency.<ref name="DAWSON2005">{{cite journal | vauthors = Dawson DA, Grant BF, Stinson FS, Chou PS, Huang B, Ruan WJ | s2cid = 19679025 | title = Recovery from DSM-IV alcohol dependence: United States, 2001–2002 | journal = Addiction | volume = 100 | issue = 3 | pages = 281–92 | date = March 2005 | pmid = 15733237 | doi = 10.1111/j.1360-0443.2004.00964.x | url = http://pubs.niaaa.nih.gov/publications/arh29-2/131-142.htm | url-status = live | archive-url = https://web.archive.org/web/20110719104620/http://pubs.niaaa.nih.gov/publications/arh29-2/131-142.htm | df = dmy-all | archive-date = 19 July 2011 | doi-access = free }}</ref>
+Rationing and moderation programs such as [[Moderation Management]] and DrinkWise do not mandate complete abstinence. While most people with alcohol use disorders are unable to limit their drinking in this way, some return to moderate drinking. A 2002 US study by the [[National Institute on Alcohol Abuse and Alcoholism]] (NIAAA) showed that 17.7% of individuals diagnosed as alcohol dependent more than one year prior returned to low-risk drinking. This group, however, showed fewer initial symptoms of dependency.<ref name="DAWSON2005">{{cite journal | vauthors = Dawson DA, Grant BF, Stinson FS, Chou PS, Huang B, Ruan WJ | s2cid = 19679025 | title = Recovery from DSM-IV alcohol dependence: United States, 2001–2002 | journal = Addiction | volume = 100 | issue = 3 | pages = 281–92 | date = March 2005 | pmid = 15733237 | doi = 10.1111/j.1360-0443.2004.00964.x | url = http://pubs.niaaa.nih.gov/publications/arh29-2/131-142.htm | url-status = live | archive-url = https://web.archive.org/web/20110719104620/http://pubs.niaaa.nih.gov/publications/arh29-2/131-142.htm | archive-date = 19 July 2011 | doi-access = free }}</ref>
-A follow-up study, using the same subjects that were judged to be in remission in 2001–2002, examined the rates of return to problem drinking in 2004–2005. The study found abstinence from alcohol was the most stable form of remission for recovering alcoholics.<ref name="DAWSON2007">{{cite journal | vauthors = Dawson DA, Goldstein RB, Grant BF | title = Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up | journal = Alcoholism: Clinical and Experimental Research | volume = 31 | issue = 12 | pages = 2036–45 | date = December 2007 | pmid = 18034696 | doi = 10.1111/j.1530-0277.2007.00536.x | url = https://zenodo.org/record/1230663 }}</ref> There was also a 1973 study showing chronic alcoholics drinking moderately again,<ref name=Sobell1973>{{cite journal|doi=10.1016/S0005-7894(73)80074-7|title=Individualized behavior therapy for alcoholics|journal=Behavior Therapy|volume=4|pages=49–72|year=1973|last1=Sobell|first1=Mark B.|last2=Sobell|first2=Linda C. }}</ref> but a 1982 follow-up showed that 95% of subjects were not able to maintain drinking in moderation over the long term.<ref name=Pendery1982>{{cite journal | vauthors = Pendery ML, Maltzman IM, West LJ | title = Controlled drinking by alcoholics? New findings and a reevaluation of a major affirmative study | journal = Science | volume = 217 | issue = 4555 | pages = 169–75 | date = July 1982 | pmid = 7089552 | doi = 10.1126/science.7089552 | bibcode = 1982Sci...217..169P }}</ref><ref name=Pendery1982NYT>{{cite news|url=https://www.nytimes.com/1982/06/28/us/alcholism-study-under-new-attack.html|title=Alcoholism Study Under New Attack|work=[[The New York Times]]|date=28 June 1982|quote=The new article will say that, 10 years later, four of the 20 had died from alcohol-related causes. Eight others were still drinking excessively, six were abstinent but in most cases after multiple hospitalizations, and one was drinking moderately. The alcohol dependence of that last case was also questioned. Another subject, who could not be found, was reported gravely disabled.}}</ref> Another study was a long-term (60 year) follow-up of two groups of alcoholic men which concluded that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence."<ref name="VAILLANT2003">{{cite journal | vauthors = Vaillant GE | title = A 60-year follow-up of alcoholic men | journal = Addiction | volume = 98 | issue = 8 | pages = 1043–51 | date = August 2003 | pmid = 12873238 | doi = 10.1046/j.1360-0443.2003.00422.x | s2cid = 12835128 }}</ref> Internet based measures appear to be useful at least in the short term.<ref>{{cite journal | vauthors = Riper H, Hoogendoorn A, Cuijpers P, Karyotaki E, Boumparis N, Mira A, Andersson G, Berman AH, Bertholet N, Bischof G, Blankers M, Boon B, Boß L, Brendryen H, Cunningham J, Ebert D, Hansen A, Hester R, Khadjesari Z, Kramer J, Murray E, Postel M, Schulz D, Sinadinovic K, Suffoletto B, Sundström C, de Vries H, Wallace P, Wiers RW, Smit JH | title = Effectiveness and treatment moderators of internet interventions for adult problem drinking: An individual patient data meta-analysis of 19 randomised controlled trials | journal = PLOS Medicine | volume = 15 | issue = 12 | pages = e1002714 | date = December 2018 | pmid = 30562347 | pmc = 6298657 | doi = 10.1371/journal.pmed.1002714 | doi-access = free }}</ref>
+A follow-up study, using the same subjects that were judged to be in remission in 2001–2002, examined the rates of return to problem drinking in 2004–2005. The study found abstinence from alcohol was the most stable form of remission for recovering alcoholics.<ref name="DAWSON2007">{{cite journal | vauthors = Dawson DA, Goldstein RB, Grant BF | title = Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up | journal = Alcoholism: Clinical and Experimental Research | volume = 31 | issue = 12 | pages = 2036–45 | date = December 2007 | pmid = 18034696 | doi = 10.1111/j.1530-0277.2007.00536.x | url = https://zenodo.org/record/1230663 | access-date = 1 July 2024 | archive-date = 25 July 2020 | archive-url = https://web.archive.org/web/20200725020723/https://zenodo.org/record/1230663 | url-status = live }}</ref> There was also a 1973 study showing chronic alcoholics drinking moderately again,<ref name=Sobell1973>{{cite journal|doi=10.1016/S0005-7894(73)80074-7|title=Individualized behavior therapy for alcoholics|journal=Behavior Therapy|volume=4|pages=49–72|year=1973|last1=Sobell|first1=Mark B.|last2=Sobell|first2=Linda C. }}</ref> but a 1982 follow-up showed that 95% of subjects were not able to maintain drinking in moderation over the long term.<ref name=Pendery1982>{{cite journal | vauthors = Pendery ML, Maltzman IM, West LJ | title = Controlled drinking by alcoholics? New findings and a reevaluation of a major affirmative study | journal = Science | volume = 217 | issue = 4555 | pages = 169–75 | date = July 1982 | pmid = 7089552 | doi = 10.1126/science.7089552 | bibcode = 1982Sci...217..169P }}</ref><ref name=Pendery1982NYT>{{cite news|url=https://www.nytimes.com/1982/06/28/us/alcholism-study-under-new-attack.html|title=Alcoholism Study Under New Attack|work=The New York Times|date=28 June 1982|quote=The new article will say that, 10 years later, four of the 20 had died from alcohol-related causes. Eight others were still drinking excessively, six were abstinent but in most cases after multiple hospitalizations, and one was drinking moderately. The alcohol dependence of that last case was also questioned. Another subject, who could not be found, was reported gravely disabled.|access-date=1 July 2024|archive-date=24 June 2020|archive-url=https://web.archive.org/web/20200624055207/https://www.nytimes.com/1982/06/28/us/alcholism-study-under-new-attack.html|url-status=live}}</ref> Another study was a long-term (60 year) follow-up of two groups of alcoholic men which concluded that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence."<ref name="VAILLANT2003">{{cite journal | vauthors = Vaillant GE | title = A 60-year follow-up of alcoholic men | journal = Addiction | volume = 98 | issue = 8 | pages = 1043–51 | date = August 2003 | pmid = 12873238 | doi = 10.1046/j.1360-0443.2003.00422.x | s2cid = 12835128 }}</ref> Internet based measures appear to be useful at least in the short term.<ref>{{cite journal | vauthors = Riper H, Hoogendoorn A, Cuijpers P, Karyotaki E, Boumparis N, Mira A, Andersson G, Berman AH, Bertholet N, Bischof G, Blankers M, Boon B, Boß L, Brendryen H, Cunningham J, Ebert D, Hansen A, Hester R, Khadjesari Z, Kramer J, Murray E, Postel M, Schulz D, Sinadinovic K, Suffoletto B, Sundström C, de Vries H, Wallace P, Wiers RW, Smit JH | title = Effectiveness and treatment moderators of internet interventions for adult problem drinking: An individual patient data meta-analysis of 19 randomised controlled trials | journal = PLOS Medicine | volume = 15 | issue = 12 | pages = e1002714 | date = December 2018 | pmid = 30562347 | pmc = 6298657 | doi = 10.1371/journal.pmed.1002714 | doi-access = free }}</ref>
 ===Medications===
 In the United States there are four approved medications for alcoholism: acamprosate, two methods of using naltrexone and disulfiram.<ref>{{cite journal |title= Alcohol and Other Drugs|url=http://pubs.niaaa.nih.gov/publications/AA76/AA76.htm |url-status=live |publisher=National Institute on Alcohol Abuse and Alcoholism |archive-url=https://web.archive.org/web/20130728134244/http://pubs.niaaa.nih.gov/publications/aa76/aa76.htm |archive-date=28 July 2013 |access-date=11 July 2013 |number=76|date=July 2008|journal=Alcohol Alert}}</ref>
-* [[Acamprosate]] may stabilise the brain chemistry that is altered due to alcohol dependence via antagonising the actions of [[glutamate]], a [[neurotransmitter]] which is hyperactive in the [[post-withdrawal]] phase.<ref>{{cite journal | vauthors = Mason BJ, Heyser CJ | s2cid = 25810236 | title = The neurobiology, clinical efficacy and safety of acamprosate in the treatment of alcohol dependence | journal = Expert Opinion on Drug Safety | volume = 9 | issue = 1 | pages = 177–88 | date = January 2010 | pmid = 20021295 | doi = 10.1517/14740330903512943 }}</ref> By reducing excessive NMDA activity which occurs at the onset of alcohol withdrawal, acamprosate can reduce or prevent alcohol withdrawal related neurotoxicity.<ref name="pmid20201812">{{cite journal | vauthors = Mason BJ, Heyser CJ | title = Acamprosate: a prototypic neuromodulator in the treatment of alcohol dependence | journal = CNS & Neurological Disorders Drug Targets | volume = 9 | issue = 1 | pages = 23–32 | date = March 2010 | pmid = 20201812 | pmc = 2853976 | doi = 10.2174/187152710790966641 }}</ref> Acamprosate reduces the risk of relapse amongst alcohol-dependent persons.<ref>{{cite journal | vauthors = Rösner S, Hackl-Herrwerth A, Leucht S, Lehert P, Vecchi S, Soyka M | title = Acamprosate for alcohol dependence | journal = The Cochrane Database of Systematic Reviews | volume = 128 | issue = 9 | pages = CD004332 | date = September 2010 | pmid = 20824837 | doi = 10.1002/14651858.CD004332.pub2 | url = http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802010000600014 | veditors = Rösner S | type = Submitted manuscript }}</ref><ref name=JAMA2014>{{cite journal | vauthors = Jonas DE, Amick HR, Feltner C, Bobashev G, Thomas K, Wines R, Kim MM, Shanahan E, Gass CE, Rowe CJ, Garbutt JC | title = Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis | journal = JAMA | volume = 311 | issue = 18 | pages = 1889–900 | date = May 2014 | pmid = 24825644 | doi = 10.1001/jama.2014.3628 | doi-access = free }}</ref>
+* [[Acamprosate]] may stabilise the brain chemistry that is altered due to alcohol dependence via antagonising the actions of [[glutamate]], a [[neurotransmitter]] which is hyperactive in the [[post-withdrawal]] phase.<ref>{{cite journal | vauthors = Mason BJ, Heyser CJ | s2cid = 25810236 | title = The neurobiology, clinical efficacy and safety of acamprosate in the treatment of alcohol dependence | journal = Expert Opinion on Drug Safety | volume = 9 | issue = 1 | pages = 177–88 | date = January 2010 | pmid = 20021295 | doi = 10.1517/14740330903512943 }}</ref> By reducing excessive NMDA activity which occurs at the onset of alcohol withdrawal, acamprosate can reduce or prevent alcohol withdrawal related neurotoxicity.<ref name="pmid20201812">{{cite journal | vauthors = Mason BJ, Heyser CJ | title = Acamprosate: a prototypic neuromodulator in the treatment of alcohol dependence | journal = CNS & Neurological Disorders Drug Targets | volume = 9 | issue = 1 | pages = 23–32 | date = March 2010 | pmid = 20201812 | pmc = 2853976 | doi = 10.2174/187152710790966641 }}</ref> Acamprosate reduces the risk of relapse amongst alcohol-dependent persons.<ref>{{cite journal | vauthors = Rösner S, Hackl-Herrwerth A, Leucht S, Lehert P, Vecchi S, Soyka M | title = Acamprosate for alcohol dependence | journal = The Cochrane Database of Systematic Reviews | volume = 128 | issue = 9 | pages = CD004332 | date = September 2010 | pmid = 20824837 | doi = 10.1002/14651858.CD004332.pub2 | url = http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802010000600014 | veditors = Rösner S | type = Submitted manuscript | access-date = 1 July 2024 | archive-date = 8 July 2020 | archive-url = https://web.archive.org/web/20200708231654/https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802010000600014 | url-status = live }}</ref><ref name=JAMA2014>{{cite journal | vauthors = Jonas DE, Amick HR, Feltner C, Bobashev G, Thomas K, Wines R, Kim MM, Shanahan E, Gass CE, Rowe CJ, Garbutt JC | title = Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis | journal = JAMA | volume = 311 | issue = 18 | pages = 1889–900 | date = May 2014 | pmid = 24825644 | doi = 10.1001/jama.2014.3628 | doi-access = free }}</ref>
 * [[Naltrexone]] is a [[competitive antagonist]] for opioid receptors, effectively blocking the effects of [[endorphin]]s and [[opioid]]s. Naltrexone is used to decrease cravings for alcohol and encourage abstinence. Alcohol causes the body to release endorphins, which in turn release dopamine and activate the reward pathways; hence in the body Naltrexone reduces the pleasurable effects from consuming alcohol.<ref>{{cite journal | vauthors = Soyka M, Rösner S | title = Opioid antagonists for pharmacological treatment of alcohol dependence – a critical review | journal = Current Drug Abuse Reviews | volume = 1 | issue = 3 | pages = 280–91 | date = November 2008 | pmid = 19630726 | doi = 10.2174/1874473710801030280 }}</ref> Evidence supports a reduced risk of relapse among alcohol-dependent persons and a decrease in excessive drinking.<ref name=JAMA2014/> [[Nalmefene]] also appears effective and works in a similar manner.<ref name=JAMA2014/>
 * [[Disulfiram]] prevents the elimination of [[acetaldehyde]], a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many [[hangover]] symptoms from alcohol use. The overall effect is discomfort when alcohol is ingested: an extremely rapid and long-lasting, uncomfortable hangover.
 Several other drugs are also used and many are under investigation.
-* [[Benzodiazepines]], while useful in the management of acute alcohol withdrawal, if used long-term can cause a worse outcome in alcoholism. Alcoholics on chronic benzodiazepines have a lower rate of achieving abstinence from alcohol than those not taking benzodiazepines. This class of drugs is commonly prescribed to alcoholics for insomnia or anxiety management.<ref>{{cite book | veditors = Lindsay SK, Powell GE |title=The Handbook of Clinical Adult Psychology |url={{google books |plainurl=y |id=a6A9AAAAIAAJ|page=380}} |edition=2nd |date=28 July 1998 |publisher=Routledge |isbn=978-0-415-07215-1 |page=402 }}</ref> Initiating prescriptions of benzodiazepines or sedative-hypnotics in individuals in recovery has a high rate of relapse with one author reporting more than a quarter of people relapsed after being prescribed sedative-hypnotics. Those who are long-term users of benzodiazepines should not be withdrawn rapidly, as severe anxiety and panic may develop, which are known risk factors for alcohol use disorder relapse. Taper regimes of 6–12 months have been found to be the most successful, with reduced intensity of withdrawal.<ref>{{cite book|last1=Gitlow |first1=Stuart |title=Substance Use Disorders: A Practical Guide |url={{google books |plainurl=y |id=rbrSdWVerBUC}} |edition=2nd |year=2006 |publisher=Lippincott Williams & Wilkins |isbn=978-0-7817-6998-3 |pages=52, 103–21}}</ref><ref>{{cite journal | vauthors = Kushner MG, Abrams K, Borchardt C | title = The relationship between anxiety disorders and alcohol use disorders: a review of major perspectives and findings | journal = Clinical Psychology Review | volume = 20 | issue = 2 | pages = 149–71 | date = March 2000 | pmid = 10721495 | doi = 10.1016/S0272-7358(99)00027-6 }}</ref>
+* [[Benzodiazepines]], while useful in the management of acute alcohol withdrawal, if used long-term can cause a worse outcome in alcoholism. Alcoholics on chronic benzodiazepines have a lower rate of achieving abstinence from alcohol than those not taking benzodiazepines. This class of drugs is commonly prescribed to alcoholics for insomnia or anxiety management.<ref>{{cite book | veditors = Lindsay SK, Powell GE |title=The Handbook of Clinical Adult Psychology |url={{google books |plainurl=y |id=a6A9AAAAIAAJ|page=380}} |edition=2nd |date=28 July 1998 |publisher=Routledge |isbn=978-0-415-07215-1 |page=402 }}</ref> Initiating prescriptions of benzodiazepines or sedative-hypnotics in individuals in recovery has a high rate of relapse with one author reporting more than a quarter of people relapsed after being prescribed sedative-hypnotics. Those who are long-term users of benzodiazepines should not be withdrawn rapidly, as severe anxiety and panic may develop, which are known risk factors for alcohol use disorder relapse. Taper regimes of 6–12 months have been found to be the most successful, with reduced intensity of withdrawal.<ref>{{cite book |last1=Gitlow |first1=Stuart |title=Substance Use Disorders: A Practical Guide |url=https://books.google.com/books?id=rbrSdWVerBUC |edition=2nd |year=2006 |publisher=Lippincott Williams & Wilkins |isbn=978-0-7817-6998-3 |pages=52, 103–21 |access-date=1 July 2024 |archive-date=14 January 2023 |archive-url=https://web.archive.org/web/20230114105317/https://books.google.com/books?id=rbrSdWVerBUC |url-status=live }}</ref><ref>{{cite journal | vauthors = Kushner MG, Abrams K, Borchardt C | title = The relationship between anxiety disorders and alcohol use disorders: a review of major perspectives and findings | journal = Clinical Psychology Review | volume = 20 | issue = 2 | pages = 149–71 | date = March 2000 | pmid = 10721495 | doi = 10.1016/S0272-7358(99)00027-6 }}</ref>
 * [[Calcium carbimide]] works in the same way as disulfiram; it has an advantage in that the occasional adverse effects of disulfiram, [[hepatotoxicity]] and drowsiness, do not occur with calcium carbimide.<ref>{{cite journal | vauthors = Ogborne AC | title = Identifying and treating patients with alcohol-related problems | journal = CMAJ | volume = 162 | issue = 12 | pages = 1705–8 | date = June 2000 | pmid = 10870503 | pmc = 1232509 }}</ref>
-* [[Ondansetron]] and [[topiramate]] are supported by tentative evidence in people with certain genetic patterns.<ref name=Soy2017/><ref name=Cs2017>{{cite journal | vauthors = Cservenka A, Yardley MM, Ray LA | title = Review: Pharmacogenetics of alcoholism treatment: Implications of ethnic diversity | journal = The American Journal on Addictions | volume = 26 | issue = 5 | pages = 516–525 | date = August 2017 | pmid = 28134463 | pmc = 5484746 | doi = 10.1111/ajad.12463 }}</ref> Evidence for ondansetron is stronger in people who have recently started to abuse alcohol.<ref name=Soy2017>{{cite journal | vauthors = Soyka M, Müller CA | title = Pharmacotherapy of alcoholism - an update on approved and off-label medications | journal = Expert Opinion on Pharmacotherapy | volume = 18 | issue = 12 | pages = 1187–1199 | date = August 2017 | pmid = 28658981 | doi = 10.1080/14656566.2017.1349098 | s2cid = 23092076 }}</ref> Topiramate is a derivative of the naturally occurring sugar monosaccharide D-fructose. Review articles characterize topiramate as showing "encouraging",<ref name="Soy2017"/> "promising",<ref name="Soy2017"/> "efficacious",<ref>{{cite journal | vauthors = Hammond CJ, Niciu MJ, Drew S, Arias AJ | title = Anticonvulsants for the treatment of alcohol withdrawal syndrome and alcohol use disorders | journal = CNS Drugs | volume = 29 | issue = 4 | pages = 293–311 | date = April 2015 | pmid = 25895020 | pmc = 5759952 | doi = 10.1007/s40263-015-0240-4 }}</ref> and "insufficient"<ref>{{cite journal | vauthors = Pani PP, Trogu E, Pacini M, Maremmani I | title = Anticonvulsants for alcohol dependence | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 2 | pages = CD008544 | date = February 2014 | pmid = 24523233 | doi = 10.1002/14651858.CD008544.pub2 | pmc = 10585425 | quote = At the current stage of research, evidence supporting the clinical use of anticonvulsants to treat alcohol dependence is insufficient. Results are conditioned by heterogeneity and by the low number and quality of studies comparing anticonvulsants versus other medications. The uncertainty associated with these results leaves to clinicians the need to balance the possible benefits/risks of treatment with anticonvulsants versus other medications as supported by evidence of efficacy. }}</ref> results in the treatment of alcohol use disorders.
+* [[Ondansetron]] and [[topiramate]] are supported by tentative evidence in people with certain genetic patterns.<ref name=Soy2017/><ref name=Cs2017>{{cite journal | vauthors = Cservenka A, Yardley MM, Ray LA | title = Review: Pharmacogenetics of alcoholism treatment: Implications of ethnic diversity | journal = The American Journal on Addictions | volume = 26 | issue = 5 | pages = 516–525 | date = August 2017 | pmid = 28134463 | pmc = 5484746 | doi = 10.1111/ajad.12463 }}</ref> Evidence for ondansetron is stronger in people who have recently started to abuse alcohol.<ref name=Soy2017>{{cite journal | vauthors = Soyka M, Müller CA | title = Pharmacotherapy of alcoholism – an update on approved and off-label medications | journal = Expert Opinion on Pharmacotherapy | volume = 18 | issue = 12 | pages = 1187–1199 | date = August 2017 | pmid = 28658981 | doi = 10.1080/14656566.2017.1349098 | s2cid = 23092076 }}</ref> Topiramate is a derivative of the naturally occurring sugar monosaccharide D-fructose. Review articles characterize topiramate as showing "encouraging",<ref name="Soy2017"/> "promising",<ref name="Soy2017"/> "efficacious",<ref>{{cite journal | vauthors = Hammond CJ, Niciu MJ, Drew S, Arias AJ | title = Anticonvulsants for the treatment of alcohol withdrawal syndrome and alcohol use disorders | journal = CNS Drugs | volume = 29 | issue = 4 | pages = 293–311 | date = April 2015 | pmid = 25895020 | pmc = 5759952 | doi = 10.1007/s40263-015-0240-4 }}</ref> and "insufficient"<ref>{{cite journal | vauthors = Pani PP, Trogu E, Pacini M, Maremmani I | title = Anticonvulsants for alcohol dependence | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 2 | pages = CD008544 | date = February 2014 | pmid = 24523233 | doi = 10.1002/14651858.CD008544.pub2 | pmc = 10585425 | quote = At the current stage of research, evidence supporting the clinical use of anticonvulsants to treat alcohol dependence is insufficient. Results are conditioned by heterogeneity and by the low number and quality of studies comparing anticonvulsants versus other medications. The uncertainty associated with these results leaves to clinicians the need to balance the possible benefits/risks of treatment with anticonvulsants versus other medications as supported by evidence of efficacy. }}</ref> results in the treatment of alcohol use disorders.
 Evidence does not support the use of [[selective serotonin reuptake inhibitors]] (SSRIs), [[tricyclic antidepressants]] (TCAs), [[antipsychotic]]s, or [[gabapentin]].<ref name=JAMA2014/>
@@ Line 253: / Line 253: @@
 [[Topiramate]], a derivative of the naturally occurring sugar monosaccharide D-fructose, has been found effective in helping alcoholics quit or cut back on the amount they drink. Evidence suggests that topiramate antagonizes excitatory glutamate receptors, inhibits dopamine release, and enhances inhibitory gamma-aminobutyric acid function. A 2008 review of the effectiveness of topiramate concluded that the results of published trials are promising, however as of 2008, data was insufficient to support using topiramate in conjunction with brief weekly compliance counseling as a first-line agent for alcohol dependence.<ref>{{cite journal|author=Olmsted CL, Kockler DR |title=Topiramate for alcohol dependence|journal=Ann Pharmacother |volume=42 |issue=10 |pages=1475–80 |date=October 2008 |pmid=18698008 |doi=10.1345/aph.1L157 |s2cid=27071889|issn=1060-0280}}</ref> A 2010 review found that topiramate may be superior to existing alcohol pharmacotherapeutic options. Topiramate effectively reduces craving and alcohol withdrawal severity as well as improving quality-of-life-ratings.<ref>{{cite journal| last1 = Kenna | first1 = GA. | last2 = Lomastro | first2 = TL. |last3 = Schiesl | first3 = A. | last4 = Leggio | first4 = L. | last5 = Swift | first5 = RM. | title = Review of topiramate: an antiepileptic for the treatment of alcohol dependence | journal = Curr Drug Abuse Rev | volume = 2 | issue = 2 | pages = 135–42 |date=May 2009 | doi = 10.2174/1874473710902020135| pmid = 19630744 }}</ref>
-[[Baclofen]], a [[GABAB receptor|GABA<sub>B</sub> receptor]] agonist, is under study for the treatment of alcoholism.<ref>{{cite journal|last=Leggio|first=L|author2=Garbutt, JC|author3= Addolorato, G|title=Effectiveness and safety of baclofen in the treatment of alcohol dependent patients.|journal=CNS & Neurological Disorders Drug Targets|date=March 2010|volume=9|issue=1|pages=33–44|pmid=20201813|doi=10.2174/187152710790966614}}</ref> According to a 2017 Cochrane Systematic Review, there is insufficient evidence to determine the effectiveness or safety for the use of baclofen for withdrawal symptoms in alcoholism.<ref>{{cite journal |last1=Liu |first1=Jia |last2=Wang |first2=Lu-Ning |date=20 August 2017 |title=Baclofen for alcohol withdrawal |journal=The Cochrane Database of Systematic Reviews |volume=8 |issue=8 |pages=CD008502 |doi=10.1002/14651858.CD008502.pub5 |issn=1469-493X |pmc=6483686 |pmid=28822350}}</ref> [[Psilocybin]]-assisted psychotherapy is under study for the treatment of patients with alcohol use disorder.<ref>{{cite web |last=Sullivan |first=Kaitlin |date=24 August 2022 |title=Does psilocybin change your brain? How the ingredient in magic mushrooms may ease addiction |url=https://www.nbcnews.com/health/mental-health/psilocybin-mushroom-help-people-alcohol-use-disorder-rcna44180 |access-date=7 September 2022 |publisher=NBC News |language=en}}</ref><ref>{{cite journal |last=Bogenschutz |date=24 August 2022 |title=Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder – A Randomized Clinical Trial |url=https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2795625 |access-date=7 September 2022 |journal=JAMA Psychiatry |volume=79 |issue=10 |pages=953–962 |doi=10.1001/jamapsychiatry.2022.2096 |pmid=36001306 |pmc=9403854 |s2cid=251766399 }}</ref>
+[[Baclofen]], a [[GABAB receptor|GABA<sub>B</sub> receptor]] agonist, is under study for the treatment of alcoholism.<ref>{{cite journal|last=Leggio|first=L|author2=Garbutt, JC|author3= Addolorato, G|title=Effectiveness and safety of baclofen in the treatment of alcohol dependent patients.|journal=CNS & Neurological Disorders Drug Targets|date=March 2010|volume=9|issue=1|pages=33–44|pmid=20201813|doi=10.2174/187152710790966614}}</ref> According to a 2017 Cochrane Systematic Review, there is insufficient evidence to determine the effectiveness or safety for the use of baclofen for withdrawal symptoms in alcoholism.<ref>{{cite journal |last1=Liu |first1=Jia |last2=Wang |first2=Lu-Ning |date=20 August 2017 |title=Baclofen for alcohol withdrawal |journal=The Cochrane Database of Systematic Reviews |volume=8 |issue=8 |pages=CD008502 |doi=10.1002/14651858.CD008502.pub5 |issn=1469-493X |pmc=6483686 |pmid=28822350}}</ref> [[Psilocybin]]-assisted psychotherapy is under study for the treatment of patients with alcohol use disorder.<ref>{{cite web |last=Sullivan |first=Kaitlin |date=24 August 2022 |title=Does psilocybin change your brain? How the ingredient in magic mushrooms may ease addiction |url=https://www.nbcnews.com/health/mental-health/psilocybin-mushroom-help-people-alcohol-use-disorder-rcna44180 |access-date=7 September 2022 |publisher=NBC News|archive-date=6 September 2022 |archive-url=https://web.archive.org/web/20220906184507/https://www.nbcnews.com/health/mental-health/psilocybin-mushroom-help-people-alcohol-use-disorder-rcna44180 |url-status=live }}</ref><ref>{{cite journal |last=Bogenschutz |date=24 August 2022 |title=Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder – A Randomized Clinical Trial |url=https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2795625 |access-date=7 September 2022 |journal=JAMA Psychiatry |volume=79 |issue=10 |pages=953–962 |doi=10.1001/jamapsychiatry.2022.2096 |pmid=36001306 |pmc=9403854 |s2cid=251766399 |archive-date=5 September 2022 |archive-url=https://web.archive.org/web/20220905183036/https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2795625 |url-status=live }}</ref>
 ===Dual addictions and dependencies===
-Alcoholics may also require treatment for other psychotropic [[drug addiction]]s and [[Substance dependence|drug dependencies]]. The most common dual dependence syndrome with alcohol dependence is [[benzodiazepine dependence]], with studies showing 10–20% of alcohol-dependent individuals had problems of dependence and/or misuse problems of benzodiazepine drugs such as [[diazepam]] or [[clonazepam]]. These drugs are, like alcohol, [[depressant]]s. Benzodiazepines may be used legally, if they are prescribed by doctors for anxiety problems or other mood disorders, or they may be purchased as [[illegal drugs]]. Benzodiazepine use increases cravings for alcohol and the volume of alcohol consumed by problem drinkers.<ref>{{cite journal | vauthors = Poulos CX, Zack M | s2cid = 23040302 | title = Low-dose diazepam primes motivation for alcohol and alcohol-related semantic networks in problem drinkers | journal = Behavioural Pharmacology | volume = 15 | issue = 7 | pages = 503–12 | date = November 2004 | pmid = 15472572 | doi = 10.1097/00008877-200411000-00006 }}</ref> Benzodiazepine dependency requires careful reduction in dosage to avoid [[benzodiazepine withdrawal syndrome]] and other health consequences. Dependence on other sedative-hypnotics such as [[zolpidem]] and [[zopiclone]] as well as [[opiate]]s and illegal drugs is common in alcoholics. Alcohol itself is a sedative-hypnotic and is cross-tolerant with other sedative-hypnotics such as [[barbiturate]]s, benzodiazepines and [[nonbenzodiazepine]]s. Dependence upon and withdrawal from sedative-hypnotics can be medically severe and, as with alcohol withdrawal, there is a risk of [[psychosis]] or [[seizure]]s if not properly managed.<ref name="dolpdaa">{{cite journal | vauthors = Johansson BA, Berglund M, Hanson M, Pöhlén C, Persson I | title = Dependence on legal psychotropic drugs among alcoholics | journal = Alcohol and Alcoholism | volume = 38 | issue = 6 | pages = 613–8 | date = November 2003 | pmid = 14633651 | doi = 10.1093/alcalc/agg123 | df = dmy-all | doi-access = free }}</ref>
+Alcoholics may also require treatment for other psychotropic [[drug addiction]]s and [[Substance dependence|drug dependencies]]. The most common dual dependence syndrome with alcohol dependence is [[benzodiazepine dependence]], with studies showing 10–20% of alcohol-dependent individuals had problems of dependence and/or misuse problems of benzodiazepine drugs such as [[diazepam]] or [[clonazepam]]. These drugs are, like alcohol, [[depressant]]s. Benzodiazepines may be used legally, if they are prescribed by doctors for anxiety problems or other mood disorders, or they may be purchased as [[illegal drugs]]. Benzodiazepine use increases cravings for alcohol and the volume of alcohol consumed by problem drinkers.<ref>{{cite journal | vauthors = Poulos CX, Zack M | s2cid = 23040302 | title = Low-dose diazepam primes motivation for alcohol and alcohol-related semantic networks in problem drinkers | journal = Behavioural Pharmacology | volume = 15 | issue = 7 | pages = 503–12 | date = November 2004 | pmid = 15472572 | doi = 10.1097/00008877-200411000-00006 }}</ref> Benzodiazepine dependency requires careful reduction in dosage to avoid [[benzodiazepine withdrawal syndrome]] and other health consequences. Dependence on other sedative-hypnotics such as [[zolpidem]] and [[zopiclone]] as well as [[opiate]]s and illegal drugs is common in alcoholics. Alcohol itself is a sedative-hypnotic and is cross-tolerant with other sedative-hypnotics such as [[barbiturate]]s, benzodiazepines and [[nonbenzodiazepine]]s. Dependence upon and withdrawal from sedative-hypnotics can be medically severe and, as with alcohol withdrawal, there is a risk of [[psychosis]] or [[seizure]]s if not properly managed.<ref name="dolpdaa">{{cite journal | vauthors = Johansson BA, Berglund M, Hanson M, Pöhlén C, Persson I | title = Dependence on legal psychotropic drugs among alcoholics | journal = Alcohol and Alcoholism | volume = 38 | issue = 6 | pages = 613–8 | date = November 2003 | pmid = 14633651 | doi = 10.1093/alcalc/agg123 | doi-access = free }}</ref>
 ==Epidemiology==
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-[[File:Alcohol consumption per person, OWID.svg|thumb|upright=1.5|Alcohol consumption per person 2016<ref>{{cite web |title=Alcohol consumption per person |url=https://ourworldindata.org/grapher/total-alcohol-consumption-per-capita-litres-of-pure-alcohol |website=Our World in Data |access-date=5 March 2020}}</ref>]]
+[[File:Alcohol consumption per person, OWID.svg|thumb|upright=1.5|Alcohol consumption per person 2016<ref>{{cite web |title=Alcohol consumption per person |url=https://ourworldindata.org/grapher/total-alcohol-consumption-per-capita-litres-of-pure-alcohol |website=Our World in Data |access-date=5 March 2020 |archive-date=16 March 2020 |archive-url=https://web.archive.org/web/20200316145124/https://ourworldindata.org/grapher/total-alcohol-consumption-per-capita-litres-of-pure-alcohol |url-status=live }}</ref>]]
 The [[World Health Organization]] estimates that {{as of|2016|lc=y}} there are about 380&nbsp;million people with alcoholism worldwide (5.1% of the population over 15 years of age),<ref name=WHO2018 /><ref name=un2020 /> with it being most common among males and young adults.<ref name=DSM5/> Geographically, it is least common in Africa (1.1% of the population) and has the highest rates in [[Eastern Europe]] (11%).<ref name=DSM5/>
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 {{as of|2015}} in the United States, about 17&nbsp;million (7%) of adults and 0.7&nbsp;million (2.8%) of those age 12 to 17 years of age are affected.<ref name=NIH2015Stats>{{cite web|title=Alcohol Facts and Statistics|url=http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics|access-date=9 May 2015|url-status=live|archive-url=https://web.archive.org/web/20150518081638/http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics|archive-date=18 May 2015}}</ref> About 12% of American adults have had an alcohol dependence problem at some time in their life.<ref>{{cite journal |vauthors=Hasin DS, Stinson FS, Ogburn E, Grant BF |title=Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions |journal=Archives of General Psychiatry |volume=64 |issue=7 |pages=830–42 |date=July 2007 |pmid=17606817 |doi=10.1001/archpsyc.64.7.830 |doi-access=free}}</ref>
-In the United States and Western Europe, 10–20% of men and 5–10% of women at some point in their lives will meet criteria for alcoholism.<ref>{{cite encyclopedia |url=https://www.britannica.com/EBchecked/topic/13448/alcoholism |title=alcoholism |year=2010 |encyclopedia=Encyclopædia Britannica |url-status=live |archive-url=https://web.archive.org/web/20101202043009/https://www.britannica.com/EBchecked/topic/13448/alcoholism |archive-date=2 December 2010}}</ref> In England, the number of "dependent drinkers" was calculated as over 600,000 in 2019.<ref name="cosu">{{cite web|url=https://www.gov.uk/government/publications/alcohol-dependence-prevalence-in-england|title=Alcohol dependence prevalence in England|date=18 March 2021|website=GOV.UK}}</ref> [[Estonia]] had the highest death rate from alcohol in Europe in 2015 at 8.8 per 100,000 population.<ref>{{cite book|vauthors=Ballas D, Dorling D, Hennig B|title=The Human Atlas of Europe|url={{google books |plainurl=y |id=z1ClDgAAQBAJThe}}|date=2017|publisher=Policy Press|location=Bristol|isbn=978-1-4473-1354-0|page=73}}{{dead link|date=May 2023 |bot=InternetArchiveBot |fix-attempted=yes}}</ref> In the United States, 30% of people admitted to hospital have a problem related to alcohol.<ref>{{cite journal |vauthors=Vonghia L, Leggio L, Ferrulli A, Bertini M, Gasbarrini G, Addolorato G |title=Acute alcohol intoxication |journal=European Journal of Internal Medicine |volume=19 |issue=8 |pages=561–7 |date=December 2008 |pmid=19046719 |doi=10.1016/j.ejim.2007.06.033}}</ref>
+In the United States and Western Europe, 10–20% of men and 5–10% of women at some point in their lives will meet criteria for alcoholism.<ref>{{cite encyclopedia |url=https://www.britannica.com/EBchecked/topic/13448/alcoholism |title=alcoholism |year=2010 |encyclopedia=Encyclopædia Britannica |url-status=live |archive-url=https://web.archive.org/web/20101202043009/https://www.britannica.com/EBchecked/topic/13448/alcoholism |archive-date=2 December 2010}}</ref> In England, the number of "dependent drinkers" was calculated as over 600,000 in 2019.<ref name="cosu">{{cite web|url=https://www.gov.uk/government/publications/alcohol-dependence-prevalence-in-england|title=Alcohol dependence prevalence in England|date=18 March 2021|website=GOV.UK|access-date=1 July 2024|archive-date=1 May 2024|archive-url=https://web.archive.org/web/20240501215857/https://www.gov.uk/government/publications/alcohol-dependence-prevalence-in-england|url-status=live}}</ref> [[Estonia]] had the highest death rate from alcohol in Europe in 2015 at 8.8 per 100,000 population.<ref>{{cite book|vauthors=Ballas D, Dorling D, Hennig B|title=The Human Atlas of Europe|url={{google books |plainurl=y |id=z1ClDgAAQBAJThe}}|date=2017|publisher=Policy Press|location=Bristol|isbn=978-1-4473-1354-0|page=73}}{{dead link|date=May 2023 |bot=InternetArchiveBot |fix-attempted=yes}}</ref> In the United States, 30% of people admitted to hospital have a problem related to alcohol.<ref>{{cite journal |vauthors=Vonghia L, Leggio L, Ferrulli A, Bertini M, Gasbarrini G, Addolorato G |title=Acute alcohol intoxication |journal=European Journal of Internal Medicine |volume=19 |issue=8 |pages=561–7 |date=December 2008 |pmid=19046719 |doi=10.1016/j.ejim.2007.06.033}}</ref>
 Within the medical and scientific communities, there is a broad consensus regarding alcoholism as a disease state. For example, the American Medical Association considers alcohol a drug and states that "drug addiction is a chronic, relapsing brain disease characterized by compulsive drug seeking and use despite often devastating consequences. It results from a complex interplay of biological vulnerability, environmental exposure, and developmental factors (e.g., stage of brain maturity)."<ref name="autogenerated1">{{cite web|last=Volkow|first=Nora|title=Science of Addiction|url=http://www.ama-assn.org/ama1/pub/upload/mm/388/sci_drug_addiction.pdf|url-status=live|archive-url=https://web.archive.org/web/20110629022654/http://www.ama-assn.org/ama1/pub/upload/mm/388/sci_drug_addiction.pdf|archive-date=29 June 2011|publisher=American Medical Association}}</ref> Alcoholism has a higher prevalence among men, though, in recent decades, the proportion of female alcoholics has increased.<ref name="Walter H., Gutierrez K., Ramskogler K., Hertling I., Dvorak A., Lesch O.M., et al. 2003 253–268">{{cite journal |vauthors=Walter H, Gutierrez K, Ramskogler K, Hertling I, Dvorak A, Lesch OM |s2cid=6972064 |title=Gender-specific differences in alcoholism: implications for treatment |journal=Archives of Women's Mental Health |volume=6 |issue=4 |pages=253–8 |date=November 2003 |pmid=14628177 |doi=10.1007/s00737-003-0014-8}}</ref> Current evidence indicates that in both men and women, alcoholism is 50–60% genetically determined, leaving 40–50% for environmental influences.<ref>{{cite journal |vauthors=Dick DM, Bierut LJ |s2cid=10535003 |title=The genetics of alcohol dependence |journal=Current Psychiatry Reports |volume=8 |issue=2 |pages=151–7 |date=April 2006 |pmid=16539893 |doi=10.1007/s11920-006-0015-1 }}</ref> Most alcoholics develop alcoholism during adolescence or young adulthood.<ref name="Enoch-2006" />
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 [[File:Alcohol use disorders world map-Deaths per million persons-WHO2012.svg|thumb|upright=1.3|Alcohol use disorders deaths per million persons in 2012
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-Alcoholism often reduces a person's life expectancy by around ten years.<ref name=Schu2014/> The most common cause of death in alcoholics is from cardiovascular complications.<ref name="Zuskin-2006">{{cite journal | vauthors = Zuskin E, Jukić V, Lipozencić J, Matosić A, Mustajbegović J, Turcić N, Poplasen-Orlovac D, Bubas M, Prohić A | title = [Alcoholism—how it affects health and working capacity] | journal = Arhiv Za Higijenu Rada I Toksikologiju | volume = 57 | issue = 4 | pages = 413–26 | date = December 2006 | pmid = 17265681 }}</ref> There is a high rate of [[suicide]] in chronic alcoholics, which increases the longer a person drinks. Approximately 3–15% of alcoholics die by suicide,<ref>{{cite book|title=American Psychiatric Association practice guidelines for the treatment of psychiatric disorders|date=2006|publisher=American Psychiatric Association|location=Arlington, VA|isbn=978-0-89042-385-1|page=1346|url={{google books |plainurl=y |id=zql0AqtRSrYC|page=1346}}|url-status=live|archive-url=https://web.archive.org/web/20160529103328/https://books.google.com/books?id=zql0AqtRSrYC&pg=PA1346|archive-date=29 May 2016}}</ref> and research has found that over 50% of all suicides are associated with alcohol or [[drug dependence]]. This is believed to be due to alcohol causing physiological distortion of brain chemistry, as well as social isolation. Suicide is also very common in adolescent alcohol abusers, with 25% of suicides in adolescents being related to alcohol abuse.<ref name="understanding_suicidal_behaviour_a02">{{cite book| last1 = O'Connor | first1 = Rory | last2 = Sheehy | first2 = Noel | title = Understanding suicidal behaviour | url = {{google books |plainurl=y |id=79hEYGdDA3oC}} | date = 29 January 2000 | publisher = BPS Books | location = Leicester | isbn = 978-1-85433-290-5 | pages = 33–37 }}</ref> Among those with [[alcohol dependence]] after one year, some met the criteria for low-risk drinking, even though only 26% of the group received any treatment, with the breakdown as follows: 25% were found to be still dependent, 27% were in partial remission (some symptoms persist), 12% asymptomatic drinkers (consumption increases chances of relapse) and 36% were fully recovered&nbsp;– made up of 18% low-risk drinkers plus 18% abstainers.<ref name="NIAAA2002">{{cite web|url=http://www.nih.gov/news/pr/jan2005/niaaa-18.htm |title=2001–2002 Survey Finds That Many Recover From Alcoholism |last1=The National Institute on Alcohol Abuse and Alcoholism |last2=U.S. Department of Health and Human Services, NIH News |date=18 January 2005 |publisher=National Institutes of Health |archive-url=https://web.archive.org/web/20060818230335/http://www.nih.gov/news/pr/jan2005/niaaa-18.htm |archive-date=18 August 2006 }}</ref> In contrast, however, the results of a long-term (60-year) follow-up of two groups of alcoholic men indicated that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence....return-to-controlled drinking, as reported in short-term studies, is often a mirage."<ref name="VAILLANT2003"/>
+Alcoholism often reduces a person's life expectancy by around ten years.<ref name=Schu2014/> The most common cause of death in alcoholics is from cardiovascular complications.<ref name="Zuskin-2006">{{cite journal | vauthors = Zuskin E, Jukić V, Lipozencić J, Matosić A, Mustajbegović J, Turcić N, Poplasen-Orlovac D, Bubas M, Prohić A | title = [Alcoholism—how it affects health and working capacity] | journal = Arhiv Za Higijenu Rada I Toksikologiju | volume = 57 | issue = 4 | pages = 413–26 | date = December 2006 | pmid = 17265681 }}</ref> There is a high rate of [[suicide]] in chronic alcoholics, which increases the longer a person drinks. Approximately 3–15% of alcoholics die by suicide,<ref>{{cite book|title=American Psychiatric Association practice guidelines for the treatment of psychiatric disorders|date=2006|publisher=American Psychiatric Association|location=Arlington, VA|isbn=978-0-89042-385-1|page=1346|url={{google books |plainurl=y |id=zql0AqtRSrYC|page=1346}}|url-status=live|archive-url=https://web.archive.org/web/20160529103328/https://books.google.com/books?id=zql0AqtRSrYC&pg=PA1346|archive-date=29 May 2016}}</ref> and research has found that over 50% of all suicides are associated with alcohol or [[drug dependence]]. This is believed to be due to alcohol causing physiological distortion of brain chemistry, as well as social isolation. Suicide is also common in adolescent alcohol abusers. Research in 2000 found that 25% of suicides in adolescents were related to alcohol abuse.<ref name="understanding_suicidal_behaviour_a02">{{cite book | last1 = O'Connor | first1 = Rory | last2 = Sheehy | first2 = Noel | title = Understanding suicidal behaviour | url = https://books.google.com/books?id=79hEYGdDA3oC | date = 29 January 2000 | publisher = BPS Books | location = Leicester | isbn = 978-1-85433-290-5 | pages = 33–37 | access-date = 1 July 2024 | archive-date = 13 January 2023 | archive-url = https://web.archive.org/web/20230113005830/https://books.google.com/books?id=79hEYGdDA3oC | url-status = live }}</ref>
+Among those with [[alcohol dependence]] after one year, some met the criteria for low-risk drinking, even though only 26% of the group received any treatment, with the breakdown as follows: 25% were found to be still dependent, 27% were in partial remission (some symptoms persist), 12% asymptomatic drinkers (consumption increases chances of relapse) and 36% were fully recovered&nbsp;– made up of 18% low-risk drinkers plus 18% abstainers.<ref name="NIAAA2002">{{cite web|url=http://www.nih.gov/news/pr/jan2005/niaaa-18.htm |title=2001–2002 Survey Finds That Many Recover From Alcoholism |last1=The National Institute on Alcohol Abuse and Alcoholism |last2=U.S. Department of Health and Human Services, NIH News |date=18 January 2005 |publisher=National Institutes of Health |archive-url=https://web.archive.org/web/20060818230335/http://www.nih.gov/news/pr/jan2005/niaaa-18.htm |archive-date=18 August 2006 }}</ref> In contrast, however, the results of a long-term (60-year) follow-up of two groups of alcoholic men indicated that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence....return-to-controlled drinking, as reported in short-term studies, is often a mirage."<ref name="VAILLANT2003"/>
 ==History==
 [[File:Adriaen Brouwer - Inn with drunken peasants.jpg|thumb|[[Adriaen Brouwer]], ''Inn with Drunken Peasants'', 1620s]]
 [[File:1904 Claim of Alcoholism Being Disease4.jpg|thumb|upright=0.7|right|1904 advertisement describing alcoholism as a disease]]
-Historically the name ''[[dipsomania]]'' was coined by German physician [[Christoph Wilhelm Hufeland|C. W. Hufeland]] in 1819 before it was superseded by ''alcoholism''.<ref name="lexikon_psychiatrie_psychotherapie_medizinische_psychologie">{{cite book| last1 = Peters | first1 = Uwe Henrik | title = Lexikon Psychiatrie, Psychotherapie, Medizinische Psychologie|url={{google books |plainurl=y |id=qY6_DQAAQBAJ}} | year = 2007 | publisher = Urban Fischer bei Elsev | isbn = 978-3-437-15061-6 }}</ref><ref>{{cite book| last = Valverde | first = Mariana | title = Diseases of the Will |page=48|url={{google books |plainurl=y |id=Kl5ugmvDgH0C|page=4848}} | publisher = Cambridge University Press | location = Cambridge | year = 1998 | isbn = 978-0-521-64469-3 }}</ref> That term now has a more specific meaning.<ref>{{cite book |last1=Tracy | first1 = Sarah J. | title = Alcoholism in America: from reconstruction to prohibition | url = {{google books |plainurl=y |id=JkYyd4qmme0C|page=31}} | year= 2005 | publisher = Johns Hopkins University Press | location = Baltimore | isbn = 978-0-8018-8119-0 | pages = 31–52 }}</ref> The term ''alcoholism'' was first used by Swedish physician [[Magnus Huss]] in an 1852 publication to describe the systemic adverse effects of alcohol.<ref name=huss1852 />
+Historically the name ''[[dipsomania]]'' was coined by German physician [[Christoph Wilhelm Hufeland|C. W. Hufeland]] in 1819 before it was superseded by ''alcoholism''.<ref name="lexikon_psychiatrie_psychotherapie_medizinische_psychologie">{{cite book| last1 = Peters | first1 = Uwe Henrik | title = Lexikon Psychiatrie, Psychotherapie, Medizinische Psychologie|url={{google books |plainurl=y |id=qY6_DQAAQBAJ}} | year = 2007 | publisher = Urban Fischer bei Elsev | isbn = 978-3-437-15061-6 }}</ref><ref>{{cite book | last = Valverde | first = Mariana | title = Diseases of the Will | page = 48 | url = https://books.google.com/books?id=Kl5ugmvDgH0C&pg=PA4848 | publisher = Cambridge University Press | location = Cambridge | year = 1998 | isbn = 978-0-521-64469-3 | access-date = 1 July 2024 | archive-date = 14 January 2023 | archive-url = https://web.archive.org/web/20230114105317/https://books.google.com/books?id=Kl5ugmvDgH0C&pg=PA4848 | url-status = live }}</ref> That term now has a more specific meaning.<ref>{{cite book |last1=Tracy | first1 = Sarah J. | title = Alcoholism in America: from reconstruction to prohibition | url = {{google books |plainurl=y |id=JkYyd4qmme0C|page=31}} | year= 2005 | publisher = Johns Hopkins University Press | location = Baltimore | isbn = 978-0-8018-8119-0 | pages = 31–52 }}</ref> The term ''alcoholism'' was first used by Swedish physician [[Magnus Huss]] in an 1852 publication to describe the systemic adverse effects of alcohol.<ref name=huss1852 />
 Alcohol has a long history of use and misuse throughout recorded history. Biblical, Egyptian and Babylonian sources record the history of abuse and dependence on alcohol. In some ancient cultures alcohol was worshiped and in others, its misuse was condemned. Excessive alcohol misuse and drunkenness were recognized as causing social problems even thousands of years ago. However, the defining of habitual drunkenness as it was then known as and its adverse consequences were not well established medically until the 18th century. In 1647 a Greek monk named Agapios was the first to document that chronic alcohol misuse was associated with toxicity to the nervous system and body which resulted in a range of medical disorders such as seizures, paralysis, and internal bleeding. In the 1910s and 1920s, the effects of alcohol misuse and chronic drunkenness boosted membership of the [[temperance movement]] and led to the [[Prohibition|prohibition of alcohol]] in many countries in North America and the Nordic countries, nationwide bans on the production, importation, transportation, and sale of alcoholic beverages that generally remained in place until the late 1920s or early 1930s; these policies resulted in the decline of death rates from cirrhosis and alcoholism.<ref name="Blocker2006">{{cite journal | vauthors = Blocker JS | title = Did prohibition really work? Alcohol prohibition as a public health innovation | journal = American Journal of Public Health | volume = 96 | issue = 2 | pages = 233–43 | date = February 2006 | pmid = 16380559 | pmc = 1470475 | doi = 10.2105/AJPH.2005.065409 | quote = Nevertheless, once Prohibition became the law of the land, many citizens decided to obey it. Referendum results in the immediate post-Volstead period showed widespread support, and the Supreme Court quickly fended off challenges to the new law. Death rates from cirrhosis and alcoholism, alcoholic psychosis hospital admissions, and drunkenness arrests all declined steeply during the latter years of the 1910s, when both the cultural and the legal climate were increasingly inhospitable to drink, and in the early years after National Prohibition went into effect. }}</ref> In 2005, alcohol dependence and misuse was estimated to cost the US economy approximately 220&nbsp;billion dollars per year, more than cancer and obesity.<ref name="soa2008">{{cite book|last1=Potter |first1= James V.|volume=2 |title=Substances of Abuse |url={{google books |plainurl=y |id=WU73eJAIDI4C|page=1}} |year= 2008 |publisher=AFS Publishing Co |isbn=978-1-930327-46-7 |pages=1–13 }}</ref>
@@ Line 306: / Line 308: @@
 ==Society and culture==
 {{see also|List of deaths through alcohol}}
-The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to society; for example, money due to lost labor-hours, medical costs due to injuries due to drunkenness and organ damage from long-term use, and secondary treatment costs, such as the costs of rehabilitation facilities and detoxification centers. Alcohol use is a major contributing factor for [[head injury|head injuries]], [[Whiplash (medicine)|motor vehicle injuries]] (27%), [[interpersonal violence]] (18%), [[suicides]] (18%), and [[epilepsy]] (13%).<ref>{{cite web |title=Alcohol and health |url=https://www.who.int/substance_abuse/infographic_alcohol_2018.pdf?ua=1 |website=WHO |access-date=3 May 2020}}</ref> Beyond the financial costs that alcohol consumption imposes, there are also significant social costs to both the alcoholic and their family and friends.<ref name="Jessica Kingsley Publishers">{{cite book |last1=McCully |first1=Chris |title=Goodbye Mr. Wonderful. Alcohol, Addition and Early Recovery |url=http://www.jkp.com/catalogue/book/9781843102656/contents |year=2004 |publisher=Jessica Kingsley Publishers |location=London |isbn=978-1-84310-265-6 |url-status=live |archive-url=https://web.archive.org/web/20091121091734/http://www.jkp.com/catalogue/book/9781843102656/contents |archive-date=21 November 2009 }}</ref> For instance, alcohol consumption by a pregnant woman can lead to an incurable and damaging condition known as [[fetal alcohol syndrome]], which often results in [[cognitive deficit]]s, mental health problems, an inability to live independently and an increased risk of criminal behaviour, all of which can cause emotional stress for parents and caregivers.<ref>{{cite book| last1 = Streissguth | first1 = Ann Pytkowicz| title = Fetal alcohol syndrome: a guide for families and communities |year=2018| publisher = Paul H Brookes Pub. |url={{google books |plainurl=y |id=kptHAAAAMAAJ}} | location = Baltimore| isbn = 978-1-55766-283-5 }}</ref><ref>{{cite web |url=https://www.cdc.gov/ncbddd/fasd/documents/FAS_guidelines_accessible.pdf |title=Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis |first1=Julie Louise |last1=Gerberding |first2=José |last2=Cordero |first3=R. Louise |last3=Floyd |date=May 2005 |publisher=US Centers for Disease Control and Prevention |url-status=live |archive-url=https://web.archive.org/web/20140611110732/http://www.cdc.gov/ncbddd/fasd/documents/FAS_guidelines_accessible.pdf |archive-date=11 June 2014 }}</ref> Estimates of the economic costs of alcohol misuse, collected by the World Health Organization, vary from 1–6% of a country's GDP.<ref>{{cite web| publisher=World Health Organization | url=https://www.who.int/substance_abuse/publications/global_status_report_2004_overview.pdf | title=Global Status Report on Alcohol 2004 | access-date=3 January 2007 | archive-url= https://web.archive.org/web/20061230103251/http://www.who.int/substance_abuse/publications/global_status_report_2004_overview.pdf| archive-date= 30 December 2006 | url-status= live}}</ref> One Australian estimate pegged alcohol's social costs at 24% of all drug misuse costs; a similar Canadian study concluded alcohol's share was 41%.<ref>{{cite web|publisher=World Health Organization Global Alcohol Database |url=https://www.who.int/globalatlas/dataQuery/objectInterface.asp?objID=359&boCat=&p=null&lvl=0&catID=520700000000&level=2 |access-date=3 January 2007 |title=Economic cost of alcohol consumption |archive-url=https://web.archive.org/web/20080118052306/http://www.who.int/globalatlas/dataQuery/objectInterface.asp?objID=359&boCat=&p=null&lvl=0&catID=520700000000&level=2 |archive-date=18 January 2008 }}</ref> One study quantified the cost to the UK of ''all'' forms of alcohol misuse in 2001 as £18.5–20&nbsp;billion.<ref name="cosu"/><ref>{{cite news | publisher=BBC | url=http://news.bbc.co.uk/1/hi/health/3122244.stm | title=Q&A: The costs of alcohol | date=19 September 2003 | url-status=live | archive-url=https://web.archive.org/web/20061019030402/http://news.bbc.co.uk/1/hi/health/3122244.stm | archive-date=19 October 2006 | df=dmy-all }}</ref> All economic costs in the United States in 2006 have been estimated at $223.5&nbsp;billion.<ref>{{cite journal | vauthors = Bouchery EE, Harwood HJ, Sacks JJ, Simon CJ, Brewer RD | title = Economic costs of excessive alcohol consumption in the U.S., 2006 | journal = American Journal of Preventive Medicine | volume = 41 | issue = 5 | pages = 516–24 | date = November 2011 | pmid = 22011424 | doi = 10.1016/j.amepre.2011.06.045 | url = http://www.sertox.com.ar/img/item_full/Bouchery_2011.pdf | access-date = 12 December 2017 | citeseerx = 10.1.1.460.5582 | archive-url = https://web.archive.org/web/20180721201648/https://www.sertox.com.ar/img/item_full/Bouchery_2011.pdf | archive-date = 21 July 2018 }}</ref>
+The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to society; for example, money due to lost labor-hours, medical costs due to injuries due to drunkenness and organ damage from long-term use, and secondary treatment costs, such as the costs of rehabilitation facilities and detoxification centers. Alcohol use is a major contributing factor for [[head injury|head injuries]], [[Whiplash (medicine)|motor vehicle injuries]] (27%), [[interpersonal violence]] (18%), [[suicides]] (18%), and [[epilepsy]] (13%).<ref>{{cite web |title=Alcohol and health |url=https://www.who.int/substance_abuse/infographic_alcohol_2018.pdf?ua=1 |publisher=World Health Organization |access-date=3 May 2020 |archive-date=25 July 2020 |archive-url=https://web.archive.org/web/20200725015946/https://www.who.int/substance_abuse/infographic_alcohol_2018.pdf?ua=1 |url-status=live }}</ref> Beyond the financial costs that alcohol consumption imposes, there are also significant social costs to both the alcoholic and their family and friends.<ref name="Jessica Kingsley Publishers">{{cite book |last1=McCully |first1=Chris |title=Goodbye Mr. Wonderful. Alcohol, Addition and Early Recovery |url=http://www.jkp.com/catalogue/book/9781843102656/contents |year=2004 |publisher=Jessica Kingsley Publishers |location=London |isbn=978-1-84310-265-6 |url-status=live |archive-url=https://web.archive.org/web/20091121091734/http://www.jkp.com/catalogue/book/9781843102656/contents |archive-date=21 November 2009 }}</ref> For instance, alcohol consumption by a pregnant woman can lead to an incurable and damaging condition known as [[fetal alcohol syndrome]], which often results in [[cognitive deficit]]s, mental health problems, an inability to live independently and an increased risk of criminal behaviour, all of which can cause emotional stress for parents and caregivers.<ref>{{cite book | last1 = Streissguth | first1 = Ann Pytkowicz | title = Fetal alcohol syndrome: a guide for families and communities | year = 2018 | publisher = Paul H Brookes Pub. | url = https://books.google.com/books?id=kptHAAAAMAAJ | location = Baltimore | isbn = 978-1-55766-283-5 | access-date = 1 July 2024 | archive-date = 14 January 2023 | archive-url = https://web.archive.org/web/20230114105318/https://books.google.com/books?id=kptHAAAAMAAJ | url-status = live }}</ref><ref>{{cite web |url=https://www.cdc.gov/ncbddd/fasd/documents/FAS_guidelines_accessible.pdf |title=Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis |first1=Julie Louise |last1=Gerberding |first2=José |last2=Cordero |first3=R. Louise |last3=Floyd |date=May 2005 |publisher=US Centers for Disease Control and Prevention |url-status=live |archive-url=https://web.archive.org/web/20140611110732/http://www.cdc.gov/ncbddd/fasd/documents/FAS_guidelines_accessible.pdf |archive-date=11 June 2014 }}</ref> Estimates of the economic costs of alcohol misuse, collected by the World Health Organization, vary from 1–6% of a country's GDP.<ref>{{cite web| publisher=World Health Organization | url=https://www.who.int/substance_abuse/publications/global_status_report_2004_overview.pdf | title=Global Status Report on Alcohol 2004 | access-date=3 January 2007 | archive-url= https://web.archive.org/web/20061230103251/http://www.who.int/substance_abuse/publications/global_status_report_2004_overview.pdf| archive-date= 30 December 2006 | url-status= live}}</ref> One Australian estimate pegged alcohol's social costs at 24% of all drug misuse costs; a similar Canadian study concluded alcohol's share was 41%.<ref>{{cite web|publisher=World Health Organization Global Alcohol Database |url=https://www.who.int/globalatlas/dataQuery/objectInterface.asp?objID=359&boCat=&p=null&lvl=0&catID=520700000000&level=2 |access-date=3 January 2007 |title=Economic cost of alcohol consumption |archive-url=https://web.archive.org/web/20080118052306/http://www.who.int/globalatlas/dataQuery/objectInterface.asp?objID=359&boCat=&p=null&lvl=0&catID=520700000000&level=2 |archive-date=18 January 2008 }}</ref> One study quantified the cost to the UK of ''all'' forms of alcohol misuse in 2001 as £18.5–20&nbsp;billion.<ref name="cosu"/><ref>{{cite news | publisher=BBC | url=http://news.bbc.co.uk/1/hi/health/3122244.stm | title=Q&A: The costs of alcohol | date=19 September 2003 | url-status=live | archive-url=https://web.archive.org/web/20061019030402/http://news.bbc.co.uk/1/hi/health/3122244.stm | archive-date=19 October 2006 }}</ref> All economic costs in the United States in 2006 have been estimated at $223.5&nbsp;billion.<ref>{{cite journal | vauthors = Bouchery EE, Harwood HJ, Sacks JJ, Simon CJ, Brewer RD | title = Economic costs of excessive alcohol consumption in the U.S., 2006 | journal = American Journal of Preventive Medicine | volume = 41 | issue = 5 | pages = 516–24 | date = November 2011 | pmid = 22011424 | doi = 10.1016/j.amepre.2011.06.045 | url = http://www.sertox.com.ar/img/item_full/Bouchery_2011.pdf | access-date = 12 December 2017 | citeseerx = 10.1.1.460.5582 | archive-url = https://web.archive.org/web/20180721201648/https://www.sertox.com.ar/img/item_full/Bouchery_2011.pdf | archive-date = 21 July 2018 }}</ref>
-{{anchor|Hitting rock bottom}}The idea of '''hitting rock bottom''' refers to an experience of [[Psychological stress|stress]] that can be attributed to alcohol misuse.<ref>{{cite web |title=hit rock bottom |url=https://idioms.thefreedictionary.com/hit+rock+bottom |access-date=16 July 2022 |website=TheFreeDictionary.com}}</ref> There is no single definition for this idea, and people may identify their own lowest points in terms of lost jobs, lost relationships, health problems, legal problems, or other consequences of alcohol misuse.<ref name=":0">{{cite journal | vauthors = Kirouac M, Witkiewitz K | title = Identifying 'Hitting Bottom' Among Individuals with Alcohol Problems: Development and Evaluation of the Noteworthy Aspects of Drinking Important to Recovery (NADIR) | journal = Substance Use & Misuse | volume = 52 | issue = 12 | pages = 1602–1615 | date = October 2017 | pmid = 28557550 | pmc = 6107067 | doi = 10.1080/10826084.2017.1293104 }}</ref> The concept is promoted by 12-step recovery groups and researchers using the [[transtheoretical model]] of motivation for behavior change.<ref name=":0" /> The first use of this slang phrase in the formal [[medical literature]] appeared in a 1965 [[Literature review|review]] in the ''British Medical Journal'',<ref name=":0" /> which said that some men refused treatment until they "hit rock bottom", but that treatment was generally more successful for "the alcohol addict who has friends and family to support him" than for impoverished and homeless addicts.<ref>{{cite journal | title = Treatment of Alcohol Addiction | journal = British Medical Journal | volume = 2 | issue = 5455 | pages = 184–5 | date = July 1965 | pmid = 20790596 | pmc = 1846501 | doi = 10.1136/bmj.2.5455.184 }}</ref>
+{{anchor|Hitting rock bottom}}The idea of '''hitting rock bottom''' refers to an experience of [[Psychological stress|stress]] that can be attributed to alcohol misuse.<ref>{{cite web |title=hit rock bottom |url=https://idioms.thefreedictionary.com/hit+rock+bottom |access-date=16 July 2022 |website=TheFreeDictionary.com |archive-date=16 July 2022 |archive-url=https://web.archive.org/web/20220716163516/https://idioms.thefreedictionary.com/hit+rock+bottom |url-status=live }}</ref> There is no single definition for this idea, and people may identify their own lowest points in terms of lost jobs, lost relationships, health problems, legal problems, or other consequences of alcohol misuse.<ref name=":0">{{cite journal | vauthors = Kirouac M, Witkiewitz K | title = Identifying 'Hitting Bottom' Among Individuals with Alcohol Problems: Development and Evaluation of the Noteworthy Aspects of Drinking Important to Recovery (NADIR) | journal = Substance Use & Misuse | volume = 52 | issue = 12 | pages = 1602–1615 | date = October 2017 | pmid = 28557550 | pmc = 6107067 | doi = 10.1080/10826084.2017.1293104 }}</ref> The concept is promoted by 12-step recovery groups and researchers using the [[transtheoretical model]] of motivation for behavior change.<ref name=":0" /> The first use of this slang phrase in the formal [[medical literature]] appeared in a 1965 [[Literature review|review]] in the ''British Medical Journal'',<ref name=":0" /> which said that some men refused treatment until they "hit rock bottom", but that treatment was generally more successful for "the alcohol addict who has friends and family to support him" than for impoverished and homeless addicts.<ref>{{cite journal | title = Treatment of Alcohol Addiction | journal = British Medical Journal | volume = 2 | issue = 5455 | pages = 184–5 | date = July 1965 | pmid = 20790596 | pmc = 1846501 | doi = 10.1136/bmj.2.5455.184 }}</ref>
-[[Stereotype]]s of alcoholics are often found in [[fiction]] and [[popular culture]]. The "[[town drunk]]" is a [[stock character]] in Western popular culture. Stereotypes of drunkenness may be based on [[racism]] or [[xenophobia]], as in the fictional depiction of the [[Irish people|Irish]] as heavy drinkers.<ref>{{cite web | url=http://www.finfacts.ie/Private/bestprice/alcoholdrinkconsumptionpriceseurope.htm | title=World/Global Alcohol/Drink Consumption | year=2009 | publisher=Finfacts Ireland | url-status=live | archive-url=https://web.archive.org/web/20150512161159/http://www.finfacts.ie/Private/bestprice/alcoholdrinkconsumptionpriceseurope.htm | archive-date=12 May 2015 | df=dmy-all }}</ref> Studies by social psychologists Stivers and Greeley attempt to document the perceived prevalence of high alcohol consumption amongst the Irish in America.<ref>{{cite book| last1 = Stivers | first1 = Richard | title = Hair of the dog: Irish drinking and its American stereotype |year=2000| publisher = Continuum | location = New York |url={{google books |plainurl=y |id=MH3aAAAAMAAJ}} | isbn = 978-0-8264-1218-8 }}</ref> Alcohol consumption is relatively similar between many European cultures, the United States, and Australia. In Asian countries that have a high gross domestic product, there is heightened drinking compared to other Asian countries, but it is nowhere near as high as it is in other countries like the United States. It is also inversely seen, with countries that have very low gross domestic product showing high alcohol consumption.<ref>{{cite journal | vauthors = Chen CC, Yin SJ | s2cid = 24571763 | title = Alcohol abuse and related factors in Asia | journal = International Review of Psychiatry | volume = 20 | issue = 5 | pages = 425–33 | date = October 2008 | pmid = 19012127 | doi = 10.1080/09540260802344075 }}</ref> In a study done on Korean immigrants in Canada, they reported alcohol was typically an integral part of their meal but is the only time solo drinking should occur. They also generally believe alcohol is necessary at any social event, as it helps conversations start.<ref>{{cite journal | vauthors = Kim W | s2cid = 28478567 | title = Drinking culture of elderly Korean immigrants in Canada: a focus group study | journal = Journal of Cross-Cultural Gerontology | volume = 24 | issue = 4 | pages = 339–53 | date = December 2009 | pmid = 19823926 | doi = 10.1007/s10823-009-9104-z }}</ref>
+[[Stereotype]]s of alcoholics are often found in [[fiction]] and [[popular culture]]. The "[[town drunk]]" is a [[stock character]] in Western popular culture. Stereotypes of drunkenness may be based on [[racism]] or [[xenophobia]], as in the fictional depiction of the [[Irish people|Irish]] as heavy drinkers.<ref>{{cite web | url=http://www.finfacts.ie/Private/bestprice/alcoholdrinkconsumptionpriceseurope.htm | title=World/Global Alcohol/Drink Consumption | year=2009 | publisher=Finfacts Ireland | url-status=live | archive-url=https://web.archive.org/web/20150512161159/http://www.finfacts.ie/Private/bestprice/alcoholdrinkconsumptionpriceseurope.htm | archive-date=12 May 2015 }}</ref> Studies by social psychologists Stivers and Greeley attempt to document the perceived prevalence of high alcohol consumption amongst the Irish in America.<ref>{{cite book| last1 = Stivers | first1 = Richard | title = Hair of the dog: Irish drinking and its American stereotype |year=2000| publisher = Continuum | location = New York |url={{google books |plainurl=y |id=MH3aAAAAMAAJ}} | isbn = 978-0-8264-1218-8 }}</ref> Alcohol consumption is relatively similar between many European cultures, the United States, and Australia. In Asian countries that have a high gross domestic product, there is heightened drinking compared to other Asian countries, but it is nowhere near as high as it is in other countries like the United States. It is also inversely seen, with countries that have very low gross domestic product showing high alcohol consumption.<ref>{{cite journal | vauthors = Chen CC, Yin SJ | s2cid = 24571763 | title = Alcohol abuse and related factors in Asia | journal = International Review of Psychiatry | volume = 20 | issue = 5 | pages = 425–33 | date = October 2008 | pmid = 19012127 | doi = 10.1080/09540260802344075 }}</ref> In a study done on Korean immigrants in Canada, they reported alcohol was typically an integral part of their meal but is the only time solo drinking should occur. They also generally believe alcohol is necessary at any social event, as it helps conversations start.<ref>{{cite journal | vauthors = Kim W | s2cid = 28478567 | title = Drinking culture of elderly Korean immigrants in Canada: a focus group study | journal = Journal of Cross-Cultural Gerontology | volume = 24 | issue = 4 | pages = 339–53 | date = December 2009 | pmid = 19823926 | doi = 10.1007/s10823-009-9104-z }}</ref>
 [[Peyote]], a psychoactive agent, has even shown promise in treating alcoholism. Alcohol had actually replaced peyote as [[Indigenous peoples of the Americas|Native Americans]]' psychoactive agent of choice in rituals when peyote was outlawed.<ref>{{cite journal | vauthors = French L | s2cid = 143549807 | year = 2008 | title = Psychoactive agents and Native American spirituality: Past and present | journal = Contemporary Justice Review | volume = 11 | issue = 2| pages = 155–63 | doi=10.1080/10282580802058270}}</ref>
@@ Line 335: / Line 337: @@
 ==External links==
 {{Sister project links|wikt=alcoholism|b=no|q=Alcoholism|s=no|commons=Category:Alcoholism|n=no|v=no|species=no|position=}}
-* {{Curlie|Health/Addictions/Substance_Abuse/Alcohol/|Alcohol}}
 {{Medical condition classification and resources
 | DiseasesDB     =

Classification	D ICD-11: 6C40.2 ICD-10: F10.2 ICD-9-CM: 303 OMIM: 103780 MeSH: D000437
External resources	MedlinePlus: 000944 eMedicine: article/285913

v t e Alcoholics Anonymous
History Effectiveness
Concepts	Twelve Steps Twelve Traditions Higher Power Serenity Prayer
Literature	The Big Book Twelve Steps and Twelve Traditions The Little Red Book Day by Day
People	Bill W. Dr. Bob Jim Burwell Sister Ignatia Marty Mann Carl Jung Lois W. William Duncan Silkworth Rowland Hazard III Ebby Thacher
Related	Al-Anon/Alateen Alcoholism Bill Wilson House Disease theory of alcoholism Hazelden Foundation The Oxford Group Stepping Stones Charles B. Towns
Drama	Bill W. and Dr. Bob My Name Is Bill W. When Love Is Not Enough: The Lois Wilson Story Bill W. (2012)
Category

Authority control databases
National	Germany United States France BnF data Japan Czech Republic Spain Israel
Other	Historical Dictionary of Switzerland NARA Encyclopedia of Modern Ukraine