Transcript 11 Alcoholism

ALCOHOLISM
LECTURE OUTLINE
• Historical perspective
• Diagnostic issues
• Prevalence and Canadian consumption
patterns
• Effects
• Etiology
• Treatment
ALCOHOLISM
Historical perspective
• alcohol and drug use has been around for
centuries
• N. America – impacts on aboriginal people
• Prohibition in the 1920s
• 1950s – introduction of major and minor
tranquilizers
• 1960s – recreational use of drugs
• today – proliferation of prescription drugs
ALCOHOLISM
Diagnostic issues
• Substance intoxication
• Substance abuse
• Substance dependence (addiction) –
physiological dependence, tolerance,
withdrawal; psychological dependence,
habituation
• Polysubstance abuse – synergistic
effects
ALCOHOLISM
Prevalence
Ontario Health Supplement
• highest rates for males ages 15-24 – 12% of
men, 3% of women have problems with
substance abuse
• increase in consumption from 1971 – 1987, then
sharp drop, especially use of spirits
• native youth – similar rates of alcohol abuse,
but higher rates of use of cigarettes and other
drugs (Gfellner & Hundleby, 1995)
ALCOHOLISM
Effects
• short-term – biphasic effect (euphoria, then acts
as depressant)
• long-term – vitamin B deficiency, liver disease,
appetite suppression
• fetal alcohol syndrome (FAS)
• social costs of alchoholism – health care, lost
productivity, motor vehicle accidents, suicide
• alcohol used by people with other mental
disorders – self-medication
ALCOHOLISM
Etiology
• genetics – MZ twins have concordance rates of
56% compared with 29% for DZ twins
• some suggestion that a gene on chromosome
11 is involved, related to dopamine reception
• type I alcoholism – onset of drinking in 20-30
age range, prone to liver disease,
• type II alcoholism – higher heritability
component for sons, earlier onset of drinking,
antisocial problems, but not as prone to medical
problems
ALCOHOLISM
Etiology
• Biological markers – sons of fathers with
alcoholism have higher than normal rates of fast
beta wave activity, also increased heart rate
following alcohol intake, suggesting that alcohol
is a reward; low MAO activity, particularly those
with type II
• low levels of serotonin – impulsivity,
aggression, antisocial behaviour (type II)
• Psychological factors – Freud – oral fixation,
dependency, enablers
ALCOHOLISM
Etiology
• Primary alcoholism – men who are aggressive,
bold, hedonistic
• Secondary alcoholism – use alcohol to cope
with anxiety and depression, punishment
avoidance, tension reduction
• Alcohol expectancy theory – belief that alcohol
will lead to positive outcomes such as social
skills, tension reduction, sexual performance
• Sociocultural and family factors
ALCOHOLISM
Treatment
• Minnesota model
• Drug treatment – naltrexone and antabuse
• Alcoholics Anonymous (AA)
• Behavioural treatment
• Relapse prevention
• Marital and family therapy
• Controlled drinking controversy
ALCOHOLISM
SUMMARY
• Biopsychosocial model provides the best
account for alcoholism
• A variety of approaches to treatment –
success heavily dependent on person’s
willingness to overcome problem drinking
• Problem of relapse