What is it?

Alcoholism is a condition resulting from excessive drinking of beverages that contain alcohol. Alcoholism, also known as alcohol dependence, is a disease that includes the following four symptoms:

• Physical dependence - withdrawal symptoms, such as nausea, sweating, shakiness and anxiety after stopping drinking
• Tolerance - the need to drink greater amounts of alcohol to get ‘high’
• Craving - a strong need, or urge, to drink
• Loss of control - not being able to stop drinking once drinking has begun

Heavy drinking is widespread. According to the 2013 National Drug Strategy Household Survey, 21 per cent of recent drinkers aged 14 or older put themselves or others at risk of harm while under the influence of alcohol in the previous 12 months. Overall, around 26 per cent of persons aged 14 years and over have put themselves at risk of alcohol-related harm in the short term on at least one drinking occasion during the last 12 months and 18.2 per cent of men and women over the age of 14 years consumed alcohol in a way considered risky or a high risk to health in the long term, placing themselves at increased risk of future health and social problems. Although the number of persons consuming alcohol daily, declined between 2010 (7.2%) and 2013 (6.5%) and the proportion of pregnant women abstaining during pregnancy increased slightly from 49 per cent to 53 per cent.

The major health risks of alcoholism include trauma, liver disease, heart disease, certain forms of cancer, pancreatitis and nervous system disorders (mental illness). These conditions often develop gradually and may only become evident after long-term heavy drinking. Women also tend to develop health problems before men. The liver is particularly vulnerable to diseases related to heavy drinking, most commonly alcoholic hepatitis (inflammation) or cirrhosis (scarring of the liver).

Experts have defined a second problem, called alcohol abuse, as something different from alcoholism. The difference is that those who abuse alcohol do not have an extremely strong craving for alcohol, loss of control over drinking, or physical dependence. People who abuse alcohol also can develop the physical symptoms related to alcoholism. Alcohol abuse is defined as a pattern of drinking that results in particular situations, such as failure to fulfil work, school or home duties, or having recurring alcohol-related legal problems, such as arrests for driving under the influence of alcohol.

Tests and treatment

Laboratory tests can help diagnose a case of alcoholism but no single laboratory test or combination of tests has been shown to be ideal for screening or diagnosis. There are, however, some tests that are useful in evaluating patients:

• Carbohydrate-deficient form of transferrin (CDT), a molecule involved in iron transport in blood. CDT is elevated in the blood of heavy drinkers but raised levels can also be found in a number of medical conditions. It is not useful as a screening test for alcohol abuse but may be useful in detecting those who have relapsed
• Gamma-glutamyl transferase (GGT), a liver enzyme that is increased by heavy alcohol intake but also by other forms of liver disease
• Mean cell volume (MCV), a measure of the size of red blood cells, which is increased by prolonged heavy drinking
• A blood alcohol (ethanol) level can be used to determine if a person has been drinking alcohol recently but does not diagnose alcoholism
• The GGT result is more useful than the MCV result as a ‘red flag’ to raise the suspicion that the person is drinking too much. Both of these tests are relatively poor for screening or as diagnostic tests because conditions other than alcohol abuse or alcoholism can cause elevated levels.

Physical examination also may reveal signs suggestive of alcoholism, such as evidence of injuries, a visible network of enlarged veins just under the skin around the navel (called caput medusae), fluid in the abdomen (ascites), yellowish-tone to the skin, decreased testicular size in men and poor nutritional status.

Treatment

Throughout Australia, specialist alcohol services are available. Some individuals will only need or want to learn to reduce or control their drinking while others will need to abstain from alcohol use. Alcohol services offer a wide range of interventions and treatments including brief interventions, motivational interviews, counselling, detoxification services and self-help groups. Detoxification (alcohol withdrawal) can be provided in a number of settings including hospital wards, alcohol treatment units and residential services.

A variety of drugs can be used to treat alcoholism. Benzodiazepines (Valium or similar drugs) are sometimes used during the first days after drinking stops to help a patient safely withdraw from alcohol. These drugs are not used beyond the first few days, however, because they may be very addictive.

Other drugs such as naltrexone can reduce the craving for alcohol and help prevent a person from returning, or relapsing, to heavy drinking.

Just as there is no one test for screening or diagnosing alcoholism, there is not one single drug that effectively treats alcoholism. In other words, no single drug is available that works in every case because body chemistries are slightly different and reasons for drinking are also different. Developing new and more effective drugs to treat alcoholism is a high priority for researchers.

More Information

RCPA Manual: Alcohol