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ALCOHOL DEPENDANCE

A 1997 study affirmed that high levels of prenatal alcohol exposure are associated with an increased risk for deficits in intellectual functioning, and that these occur in children lacking physical

 FEATURES required for a FAS diagnosis. Phrases other than FAS are applied. Adverse fetal effects seemingly can occur at various levels of alcohol intake. It has not been possible to define thresholds below which consumption is safe. Thus, all alcohol use during pregnancy seems potentially harmful. Consequently, most current medical literature strongly supports advising any woman who drinks alcohol who might become pregnant to take no more than one or two drinks daily, and to eliminate it completely if pregnant. Women who drink heavily also appear to have increased infertility, risk for spontaneous abortion, and irregular menstrual cycles. Fetal injury from prenatal alcohol exposure leading to birth defects can occur within the first three to eight weeks of pregnancy, before many women realize that they are pregnant. A survey by the Centers for Disease Control & Prevention (CDC) found that 12.5% of women of childbearing age (18-44 years) reported what CDC defined as "risky drinking" ([greater than] six drinks per week, or five or more drinks on any occasion). This confirms that many women who do not intend to become pregnant show little concern about alcohol use being hazardous to pregnancy. Even among surveyed women who knew they were pregnant, one out of every 29 reported a risky pattern of drinking. There are few assessments allowing an estimate of the risk associated with a pattern of episodic, non-daily heavy drinking (binging). Judging from theoretical considerations only, binge drinking coinciding with a critical early stage in organogenesis constitutes an especially high risk to a fetus. Pharmacotherapies for alcohol dependence Increasing evidence supports the efficacy of pharmacotherapy for several aspects of alcohol dependence. Significant progress has been made in managing the withdrawal reaction, decreasing consumption after detoxification, preventing relapse and controlling comorbid psychiatric illness. Useful pharmacological agents for treating alcohol dependence can be classed as: * Agents for treating the withdrawal syndrome * Aversive agents * Agents effective against comorbidity * Agents to reduce craving or prevent relapse. However, good patient compliance is essential for all successful approaches, with psychosocial interventions critical to the overall treatment strategies. Detoxification measures The primary intervention in addiction was long considered to be that of detoxification, or detox. This is the process in which a person having physical dependence to an abused drug or alcohol is withdrawn from it, often by gradual ingestion of decreasing doses or, more likely, doses of a cross-tolerant CNS drug. The primary objective is to minimize the discomfort and hazards while the patient's neurochemistry adjusts to the drug- free state. Of itself it is not a therapy for psychological dependence, and it does not alter the long-term behavior. Functional impact of alcohol on the brain

Acute intoxication:
* Acute impairment of good judgement, risky behaviors, disinhibition * Psychomotor impairments--increase in reaction time; slurred speech, diplopia, and ataxia * Sedation progressing to coma and possible death from respiratory or circulatory failure

Chronic, long-term toxicity:
* Impairment of cortical activities--judgment, cognition, self-control * Premature brain aging--failure of memory and other behavioral changes of dementia, with a possibility of psychosis * Wernicke-Korsakoff syndrome, a potentially fatal encephalopathy and/or psychosis from dietary thiamine deficiency * Psychological and physical dependence, likely abstinence syndrome--with possible delirium, psychosis, or seizures, and a high probability of relapse to abusive drinking
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