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ALCOHOL DEPENDANCE

Adverse effects of hazardous drinking

Nature of adverse effect

CIRCULATORY SYSTEM * Blood vessels: Hypertension * Heart muscle: Cardiomyopathy * Cardiac conduction system: Dysrhythmias

DIGESTIVE SYSTEM * Esophagus: Irritation; [up arrow] cancer risk; gastritis (dyspepsia), morning nausea, and emesis * Stomach: Gastritis ("dyspepsia"), morning nausea, and emesis; [up arrow] cancer risk * Small intestine: Hemorrhagic erosions, recurrent diarrhea; [down arrow] uptake of nutrients, causing malnutrition with vitamin and/ or trace element deficiency diseases * Pancreas: [up arrow] Duct stones, obstruction; [up arrow] risk of pancreatitis or cancer * Liver: Hepatitis, jaundice, cirrhosis; death after many complications

NERVOUS SYSTEM * Brain: Shrinkage of hemispheres and cortex; enlarged ventricles; dementia * Peripheral NS: Neuropathies--tremor, paresthesia, muscle weakness, impotence

ENDOCRINE SYSTEM * Male: [down arrow] Testosterone output, [down arrow] libido; feminizing of breasts (gynecomastia) * Female: Amenorrhea, premature menopause; [up arrow] risk for cancer of breast; unwanted pregnancy; fetal alcohol syndrome

OTHER * Voluntary muscles: Pain from acute myopathy after binges * Skin: Accelerated aging, wrinkles; scars; reddening, especially nose (rosacea) * Lungs: Chronic pulmonary infections * Mouth: Coated tongue, periodontal disease * Bones: [up arrow] Risk for hip/ spinal osteoporosis (men) Table 3

Causes of alcohol-associated fatalities

Behavioral toxicity * Altercations--gunshots, knifings, etc. * Accidental trauma while driving, at job or home * Drownings while intoxicated

Acute or chronic pathology * Acute overdose (cardiac/respiratory failure) * Acute cerebrovascular accident (fatal stroke) * Immune impairment (pneumonia, other infection) * Acute pancreatitis (peritonitis) * Mucosal erosion (esophagus/gastric bleeding) * Cardiomyopathy (cardiac insufficiency) * Hepatic cirrhosis (coma from encephalopathy); esophageal varices (hemorrhage) * Wernicke encephalopathy (respiratory failure) * Cancer of digestive or reproductive organs * Fatal seizures in acute withdrawal

 FEATURES of Cloninger's alcoholism types

Type I alcoholism occurs in both men and women, involves both genetic and environmental factors, and begins fairly late in life, past young adulthood, with not much criminality.

Type II alcoholism was recognized first in men, but also occurs in women. It is overwhelmingly genetic in origin, begins during adolescence or early adulthood, is associated in men with criminality, in women with sexual behavior. A predisposing factor is severe alcoholism in the birth father that entails extensive therapy and often is associated with severe criminality. It is hypothesized to arise from a deficit of brain serotonergic inhibition.

Characteristics supporting a diagnosis of FAS

* Growth retardation: low birth weight, small head (microcephaly), slowed postnatal growth
* Facial dysmorphology: altered canthus of eyelid gives a round-eyed look, hairline low on forehead, bushy brows, flat and long upper lip, tongue protuberant more than normal
* Central nervous system: serious lifelong IQ deficit, learning disabilities extending even to mental retardation; maladaptive behaviors.

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