By Ayati Mishra, Tesoro High School, Las Flores, California, United States
Article Summary
Alcohol dependence is the excessive use of alcohol, featuring an inability to stop and withdrawal symptoms (Nathan et al., 2018). It has both genetic and environmental causes, but there is no guaranteed determinant of alcohol dependence (Edenburg & Foroud, 2013). Signs of alcohol dependence can be seen in a person’s disposition and cravings for alcohol, as well as their social appearance and behavior (Mayo Clinic, 2017). Symptoms of alcohol dependence include increased alcohol tolerance, inability to quit drinking habits voluntarily, and withdrawal symptoms (National Institute on Alcohol Abuse and Alcoholism, n.d.). There is a variety of treatments available to people who struggle with alcohol dependence. Alcohol dependence is associated with many negative public health implications.
Alcohol has many different connotations around the world. To some, it is a deadly poison; while to others, it is a welcome reprieve. The World Health Organization (2022) reports that the harmful effects of alcohol are responsible for 5.3% of worldwide deaths, or three million deaths each year. Consequently, alcohol overuse, addiction, and dependence are significant health concerns in today’s society.
Disorder Description
According to Nathan et al. (2018), alcohol dependence is the excessive consumption of alcohol to the point where a person loses control of their drinking habits and alcohol is needed for regular function.
Causes of Alcohol Dependence
One factor that may increase the risk of alcohol dependence is one’s genetic makeup. Edenburg and Foroud (2013) identified a scientific study that show alcohol dependence’s strong correlation with birth parents than adoptive parents (Heath & Phil, 1995; as cited in Edenburg & Foroud, 2013). Animal studies of selective breeding in mice and rats produced traits associated with alcohol dependence. (McBride & Li, 1998; as cited in Edenburg & Foroud, 2013). The ability to produce these traits through selective breeding proves the existence of genetic components of alcohol dependence. However, it is important to identify that alcohol dependence is not a result of one, clear-cut gene. It is associated with many genes that can all interact to heighten a person’s risk of alcohol dependence (Edenburg & Foroud, 2013).
Furthermore, alcohol dependence is not caused by genes alone—genes can interact with a person’s environment to encourage or suppress the trait of alcohol dependence. For example, Americans drank 14% more alcohol in 2020 than 2019 amid the COVID-19 pandemic (Calina et al., 2021). The pandemic exacerbates one of the most common environmental causes of alcoholism: stress (Grossman et al., 2020). Alcohol is a depressant, meaning that it “suppresses central nervous system activity” and makes a person feel calmer (Jenkins et al., 2020, p. 132). Because of its calming effects, alcohol is highly addictive and especially attractive when a person is stressed or anxious.
Effects of Alcohol Dependence
Continued motivation is a central effect of alcohol dependence. The basal ganglia, a group of nuclei in the brain, regulates the reward system (National Institute on Alcohol Abuse and Alcoholism, 2021; Reynolds & Parr-Brownlie, 2015). This system is activated by the "high" associated with alcohol use.
Alcohol dependence is significantly detrimental to one’s mental and physical health. In the brain, excessive alcohol use earlier in life may cause issues in brain development and subsequent long-term effects into middle and later adulthood (National Institute on Alcohol Abuse and Alcoholism, n.d.). Moreover, the cortical regions of the brain may decrease in mass and experience degradation (Schulte et. al., 2012), affecting neural communication. In the rest of the body, excessive alcohol use has been shown to cause stroke along with liver and pancreas issues (National Institute on Alcohol Abuse and Alcoholism, n.d.). Furthermore, the National Toxicology Program (2021) has even classified alcohol as a carcinogen.
Alcohol Dependence Symptoms and Signs
Alcohol dependence is not alcohol abuse. Alcohol abuse is a regular drinking pattern where the effects of alcohol cause major negative consequences (Nathan et al., 2018). When a person repeatedly and regularly consumes alcohol, they will likely develop tolerance, where the body’s homeostasis levels are altered and that same amount of alcohol no longer has a noticeable effect. This means that more alcohol will need to be consumed to achieve the same results. The continued consumption of alcohol in excessive quantities leads to alcohol dependence, which is distinguished by the inability to stop and symptoms of withdrawal (Nathan et al., 2018).
People with alcohol dependence may be unable to stop due to uncomfortable feelings or health effects, known as withdrawal symptoms. Because alcohol is a depressant, withdrawal symptoms seem to do the opposite and stimulate the nervous system. This includes physical symptoms like a heightened heartbeat, physical excitement, and hallucinations (Becker, 2008), as well as mental symptoms like mood changes and sleep issues (Becker, 2008).
There are also many observable signs recognizable to others if a person has developed alcohol dependence. According to the Mayo Clinic (2017), these signs include an unusually neglected appearance or behavior changes, issues at school or work, or a sudden unexplainable need for money.
Treatments
There are many treatment options for people struggling with alcohol dependence. One form of treatment is cognitive-behavioral therapy (CBT) (National Institute on Alcohol Abuse and Alcoholism, 2014). In CBT, a therapist and patient can collaborate to break down the patient’s thoughts and feelings (National Health Service, 2019). Once negative thoughts are identified, they will work together to change these thoughts, thereby eliminating the negative behavior: alcohol dependence. According to a study by Magill and Ray (2009), “58% of patients receiving CBT fared better than patients in the comparison condition”.
In addition to CBT, alcohol dependence can be treated with medications such as naltrexone, acamprosate, and disulfiram (National Institute on Alcohol Abuse and Alcoholism, 2014). Naltrexone is effective in reducing excessive drinking (Heilig, 2014), and studies show that acamprosate facilitates abstinence (Heilig, 2014). Disulfiram, on the other hand, inhibits alcohol metabolism and encourages a person to stay away from alcohol by causing unpleasant reactions after alcohol consumption (Yahn et al., 2013).
Global Health Implications
Besides the individual health consequences of alcohol dependence, it also has direct effects on public health. According to Brismar et al. (1998), alcohol plays a part in almost all types of accidents or violence, impacting both the perpetrator and victim. It affects people of all ages—adolescents are influenced at an alarmingly high rate, as young people are pressured by peers and societal norms (Teunissen et al., 2012), and as well as the elderly, interfering with medication responses and their general mental health (Dufour et al., 1995). Moreover, Assari et al. (2018) explains, “socioeconomic status (SES) indicators such as education attainment have smaller protective effects on health risk behaviors for racial and ethnic minority groups in comparison to the ‘dominant’ social group”. Furthermore, in the United States, ethnic minorities such as Blacks and Hispanics are faced with additional socio-economic obstacles deterring them from quality education and healthcare. It is undeniable that to reduce the impacts of alcohol on the global society, all groups of people must be addressed.
Alcohol dependence has a significant global impact, with approximately 3 million deaths annually linked to harmful alcohol use (World Health Organization, 2022). It is a major public health issue that requires attention and efforts to reduce its harm to individuals and society.
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