Alcoholism (Alcohol Dependence)

Introduction

Alcoholism (Alcohol Dependence) is a disorder characterized by a wide spectrum of problems. Central feature is the use of alcohol, which takes an increasingly dominant place in the user’s life in spite of experience of harm related to drinking. Social and genetic factors are thought to be important in pathogenesis.
A life time prevalence of about 0.2 – 0.5% in Nigerian adult males

Clinical features

  • Tolerance
  • Withdrawal episodes
  • Compulsive desire to use alcohol
  • Associated physical, social, or occupational impairments

Differential diagnoses

  • Dependence on (and withdrawal from) other substances

Complications

  • Liver cirrhosis
  • Damage to other organs (including the brain)
  • Accidents
  • Delirium tremens
  • Increased mortality (reduce life expectancy)
  • Family, social and occupational disability

Investigations

  • Full Blood Count and differentials
  • Liver function tests
  • Other investigations as indicated for medical/physical complications

Treatment objectives

  • Reduction in alcohol consumption as an interim measure
  • Abstinence as as the desired goal
  • Rehabilitation
  • Prevention of relapse

Non-drug treatment

  • Psychosocial interventions.
  • Cognitive behavioural therapy
  • Marital and family therapy Group therapy

Drug treatment

  • Only occasionally required, and following careful assessment
  • Note: Detoxification is required for severe withdrawal syndrome or delirium tremens
  • This will involve the administration of a long-acting benzodiazepine and thiamine supplements over 7-10 days

Supportive measures

  • Rehabilitation to Sustain abstinence
  • Acquire an alcohol-free life style
  • Prevent relapse

Prevention

  • Health education (including school health education, peer group education and self help groupe.g. alcoholic anonymous)
  • Government regulation of alcohol use