This assignment discusses the subject of alcohol and dependence. It begins by briefly defining alcohol, illustrating the severity of addiction and linked health problems as identified within the United Kingdom (UK). This is followed by a discussion surrounding the diagnosis, assessment and finally the aetiology of alcohol abuse and dependence. The assignment includes both the DSM-IV-TR and bio-psycho-social perspectives. The conclusion restates the main points considered. Alcohol, known as ethanol alcohol, is a colourless liquid that acts as a central nervous system depressant and sedative.
It is usually in the form of beer, wine or spirits, is a legal substance, drunk by mouth and it cannot legally be sold to people under the age of 18 (Lynksey, Fergusson and Horwood 1994). Alcohol abuse, as defined by Bennett (2005) using the DSM-IV-TR (APA 2000) involves; “a maladaptive pattern of substance use leading to clinically significant impairment or distress” (p. 356). Alcohol abuse or dependence is defined as when its consumption poses a considerable risk to their own and others health (Heather and Robertson 2000).
Harrington-Dobinson and Blows (2007) categorise harmful drinking as drinking above recognised ‘sensible’ limits and experiencing harm. Many medical experts have identified that a large proportion of the adult population are heavy drinkers, drinking at levels leading to detectable biochemical abnormalities. Up to a quarter of all adults aged 16-24 drink to excess with 8. 2 million with a dependence upon alcohol. The mortality rate is over twice that of the normal population (Heather and Robertson 2001).
In 1987 the population of England and Wales spent £17 billion on alcohol, equivalent to £370 for every adult in Britain. In 1996, £189. 5 million was spent on promoting alcohol (Wright 1999). See appendix (figure 1) for related harm and costs. According to statistics by Harington-Dobinson and Blows (2007) by 2004 there were 130,000 adults with primary dependency syndrome recorded. Alcohol abuse or dependence can cause damage to the oesophagus resulting in acute haemorrhage (bleeding).
It can cause a surge in blood pressure not found in those consuming the same quantity spread over a longer period, (Stauber, Trauner and Fickert 2000, cited in Winger, Woods and Hofmann 2004). Continued abuse of alcohol can lead to chronic pancreatitis and cirrhosis of the liver. Stauber et al. (2000) state alcohol hepatitis, which presents as jaundice, tender hepatomegaly (enlargement and tenderness of the liver), fever, nausea and anorexia occurs in only about 20 percent of heavy drinkers; however this can result in death of liver cells leading to long-term liver damage.
Since 1995, according to Alcohol Concern statistics (2006) the UK government’s recommended maximum weekly intake is 28 units for men and 21 for women. This is used as a guideline to support a diagnosis of excessive alcohol use. As stated by King, Dawson, Neale and Johnson (2007) the pathological use of alcohol falls into two categories; the first, dependence or addiction, involves causing harm to the psychological, social, legal, interpersonal or physical wellbeing of the individual as characterized by DSM-IV-TR (see figures 2 and 3 in appendix).
The DSM-IV-TR (APA 2000) recognized that the consistent use of alcohol is a “maladaptive pattern of substance use leading to clinically significant impairment or distress” (cited in Bennett 2005, p. 356). It is diagnosed when the ingestion of alcohol affects the central nervous system and causes identifiable behavioural or cognitive effects (King et al. 2007). These can include associations with such issues as crime, abuse, human relationship difficulties, loss of personal or group esteem and economic hardship.
It is stressed, however, that alcohol dependence is not always a result of personal choice or moral weakness but rather a complex interaction of the individual’s personal makeup, social setting, culture and neurobiology (Harrington-Dobinson and Blows (2007). Alcohol dependence is diagnosed using details of both physical and other symptoms, including social and psychological considerations. This can be difficult as many individuals who are alcohol dependent attempt to hide their obsession; in many cases it is only close family members who can see their changes in behaviour and identify the problem.
Bennett (2005) suggests that there is often a pattern observed which develops from social drinking, to drinking at times of stress, to a period where alcohol is ‘needed’ to cope with personal problems. This leads to a further need for alcohol to avoid withdrawal symptoms developing, these periods of abstinence becoming shorter. For a medical diagnosis to be confirmed, if an individual is denied alcohol for any period of time then experiences withdrawal they then receive a diagnosis of alcohol dependence (King et al. 007). The individual then often experiences physical symptoms including nausea, tremor, sweating and mood changes. Assessment of alcohol abuse and dependence can be difficult. Those using alcohol socially drink openly, usually in the company of others, so are seen when excessively drinking. However, for those who become dependent on alcohol and abuse it regularly, this is more difficult, as denial of the problem is common and can mask the severity of the situation (Paton 1994).
According to the DSM-IV-TR (2000) in order to be categorized as alcohol dependent three elements of criteria need to be present, as when an individual is abusing the substance (see appendix figures 3 and 4). Alcohol dependence can often be identified by using liver function tests (LFT’s) but the social and psychological effects can only be identified by incorporating a variety of methods (Harrington-Dobinson and Blows 2007). Observations and personal information regarding an individual’s daily intake in relation to recommended units is used in the assessment process, using the DSM-IV-TR criteria to support the assessment.
Most assessments are carried out by trained community nurses working within the community, who the National Medical Council (2008) suggest are best placed to assess and then offer non-judgmental advice to help individuals deal with the situation. According to Hulse, White and Cape (2002) many individuals drink alcohol excessively over a period of time but do not become dependent on it. For many people, for example teenagers, who often drink heavily socially, their consumption reduces as they enter employment or more permanent relationships (Wright 1999) but for some the use of alcohol continues and is then abused.
Prescott and Kendler (1999) suggest that there is evidence of a genetic inclination to alcohol problems, reinforced by research carried out by Schuckit et al. (1996) cited in Bennett (2005); they discovered that individuals from families where there were high levels of ‘problem drinking’ had less physiological responses to alcohol than controlled subjects studied. It is suggested that this may lead to increased and eventually dependence.
Genetically Prescott and Kendler (1999) informed that men with family histories of problem drinking characteristically experience a greater reduction in anxiety after drinking than most other adults. Alcohol is a; “socially sanctioned drug and … is markedly sanctioned by social and environmental factors” (Bennett 2005, p. 361). The consumption of alcohol varies across different cultural and social groups, with men traditionally more likely to drink more heavily than women and abusive alcohol consumption more common amongst the young and lower-socioeconomic groups (Bennett 2005).
Approximately one third of all UK 13-14 year-olds are recorded as having been drunk more than once (Sutherland and Wilner 1998). Studies have shown that one in thirteen adults in the United Kingdom is dependent on alcohol. Social and cultural attitudes to alcohol consumption vary but the drinking of alcohol is often seen as acceptable, which in turn can encourage underage and excessive consumption, which in turn can lead to abuse and eventually dependence.
The effects of alcohol abuse and dependence can cause massive damage to many social aspects of life, particularly family relationships. According to Harrington-Dobinson and Blows (2007) research indicates that 920,000 children under the age of 18 in the UK are living with one or both parents with an alcohol problem. Further, many of these children develop behavioural or emotional problems caused as a direct effect of alcohol. These include truancy, antisocial behaviour, delinquency and poor school performance.
Social causes influence consumption once started (Sutherland and Wilner 1998). Life changes, both bad and good, can encourage alcoholic consumption (Bennett 2005) including relationships and employment issues. Parents are less effective in their parental role and research informs that children are also at more of abuse from alcoholic parents and there is also an increase in incidences of domestic violence where one parent is alcohol dependent. Social difficulties include difficulties in forming relationships and psychiatric problems (Heather and Robertson 2000).
Research has identified there are close links between alcohol dependency and mental health issues. Alcohol is often used as a means of coping with stress; “behavioural explanations of alcohol consumption consider(ing) it to the consequence if both operant and classical conditioning” (Benett 2005, p. 361). The Health Education Authority (HEA) identified heavy drinking is linked with psychiatric morbidity, including clinical depression, with alcohol being implicated in 40 percent of attempted suicides by women, Department of Health (DOH) (1995).
Approximately 20% of psychiatric admissions, 40% of domestic violence incidents, 60% of suicide attempts and 15% of all traffic deaths in the UK are attributed to alcohol abuse or dependence (Edwards, Anderson and Babor 1994). In conclusion the change in drinking culture in today’s society means drinks are now more freely available; drinking every day is a common occurrence and is considered as the cultural norm certainly by most young people in our society. The short-term physical effects of alcohol include loss of inhibitions, lack of coordination and slower reaction time, blurred vision, slurred speech and aggression.
As Blows (2003) informs the effects act as a mild mental stimulant that gives the feeling of well-being and mild euphoria. Alcohol is often associated with status, power, conviviality, attractiveness and achievement (Collins 1990) cited in Calder and Hackett (2003). Perhaps today’s society needs to re-evaluate the social acceptance and therefore often excessive use, abuse and eventual dependence of alcohol, especially its impact on the young people and adults.