The continuous or excessive use of alcohol (ethanol) with associated pathologic results. Alcoholism is characterized by constant or periodic intoxication, although the pattern of consumption varies markedly. Individuals admitted for the first time to an alcoholism treatment center typically have been consuming 3–4 oz (80–100 g) of pure alcohol per day, corresponding to seven to nine drinks or bottles of beer or glasses of wine. Studies have shown that problem drinking in these populations starts at about 2 oz/day (60 g/day), that is, four to five drinks per day, and that these are consumed in rapid succession, leading to intoxication on three or more days per week. Individuals who consume these levels of alcohol have a greater-than-average risk of developing alcoholic liver cirrhosis. However, the levels should not be taken as absolute, since they can vary greatly in different individuals, according to body weight and other factors.
The symptoms and consequences associated with severe alcohol consumption also vary greatly; that is, in some individuals only a few may be present. These may consist of the development of physical dependence manifested as a state of physical discomfort or hyperexcitability (tremors or shakes) that is reduced by continued consumption; the development of tolerance to the effects of alcohol, which leads individuals to increase their consumption; accidents while intoxicated; blackouts, characterized by loss of memory of events while intoxicated; work problems, including dismissal; loss of friends and family association; marital problems, including divorce; financial losses, including bankruptcy or continual unemployment. Medical problems can include gastric ulcers, pancreatitis, liver disease, and brain atrophy. The last is often associated with cognitive deficiencies, as shown by the inability to comprehend relatively simple instructions or to memorize a series of numbers. See also: Cognition
Individuals seeking an early treatment for their alcohol problems have very good probabilities of recovery. The lesser the number of presenting problems described above, the better the chances of favorable outcome, and so an early identification of problem drinking by family, friends, employers, or physicians becomes very important. Employee assistance programs have become an important factor in identification and referral and rehabilitation of individuals with alcohol problems in the United States, Canada, and many other countries. The types of intervention vary greatly, progressing from self-monitoring techniques, to intensive outpatient and inpatient programs, to Alcoholics Anonymous groups.
Absorption of alcohol Alcohol is absorbed most rapidly from solutions of 15–30% (30–60 proof) and less rapidly from beverages containing below 10% and over 30%. This is to be expected at the lower concentrations, since the rate of absorption depends on the concentration gradient across the mucosal surface. At higher concentrations, ethanol abolishes the rhythmic opening of the pylorus, thus preventing the passage to the intestine, where absorption is faster. The presence of food in the stomach is also known to delay gastric emptying and thus to slow absorption. Once in the bloodstream, alcohol is distributed evenly in all tissues, according to their water content. As a rule of thumb, for a 150-lb (68-kg) individual two standard drinks (1.5 oz of a distilled beverage or 13.6 g per standard drink) will yield blood alcohol levels of about 0.06 g per 100 mL of blood. It was previously believed that all ethanol consumed was absorbed into the bloodstream. However, studies have shown that a small part of the ethanol ingested is degraded directly in the stomach without entering the blood. See also: Distilled spirits; Malt beverage; Wine
Effects on the nervous system The exact mechanisms of the pharmacological actions of alcohol are not known. Alcohol can act as a stimulant at lower doses, and as a...
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Yedy Israel, Falk Kiefer, Steve Martino, "Alcoholism", in AccessScience@McGraw-Hill, http://www.accessscience.com, DOI 10.1036/1097-8542.021210
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