Chronic alcohol abuse, dependence, or addiction; chronic excessive drinking of alcoholic beverages resulting in impairment of health or of social or occupational functioning, and increasing tolerance requiring increasing doses to achieve and sustain the desired effect. Symptoms of withdrawal may occur on sudden cessation of alcohol intake.
Alcoholism is a chronic, progressive behavioral disorder characterized by a strong urge to consume ethanol and an inability to limit the amount of drinking despite adverse consequences, including social or occupational impairment and deterioration of physical health. The disorder includes both physical dependence (withdrawal symptoms such as nausea, sweating, tremors, and delirium resulting from abstinence) and tolerance (the need to increase alcohol intake to achieve the desired effect). Excessive drinking may occur daily or during binges separated by intervals of sobriety lasting from days to months. In approximately 40% of those who habitually abuse alcohol, a pattern of inappropriate drinking is evident before age 20. Alcoholism is frequently accompanied by addiction to nicotine and other drugs, anxiety, depression, and antisocial personality. It tends to run in families, but personal history and environmental factors are apparently at least as important as genetic predisposition. Behavioral traits that are typical of alcoholism include solitary drinking, morning drinking, lying about the extent of one's drinking, and maintenance of a secret supply of liquor. Chronic alcoholism decreases life expectancy by about 15 years. It is associated with an increased incidence of cardiac arrhythmia, hypertension, stroke, acute hepatitis, cirrhosis, gastritis, pancreatitis, syncope, amnesia and personality change. Because ethanol is a rich source of non-nutritive calories, heavy drinking often leads to malnutrition and vitamin deficiency. Degenerative central nervous system disorders associated with alcoholism include Wernicke encephalopathy (due to thiamine deficiency) and Korsakoff psychosis. Alcoholics are more likely than nonalcoholics to be involved in automobile accidents (more than 25% of all traffic deaths involve alcohol) and to commit violent crimes, including spousal and child abuse and homicide. A child born to an alcoholic mother may suffer the stigmata of fetal alcohol syndrome, characterized by low birth weight, facial dysmorphism, cardiac anomalies, and mental retardation. The treatment of alcoholism requires intensive counseling of patient and family. Cognitive-behavioral therapy, motivational enhancement therapy, group therapy, and support groups are all of proven value. Administration of benzodiazepines during withdrawal and use of topiramate or naltrexone to maintain abstinence are often effective. Disulfiram taken regularly can lower the risk of relapse by inducing severe malaise and nausea if alcohol is consumed. Detoxification programs for the management of acute alcoholic intoxication include withdrawal of all alcohol consumption and provision of nutritional, pharmacologic, and psychological support.