An “Alcoholic” or an Individual with “Alcohol Dependence” – What’s the Difference?
We use the term alcohol dependence to denote a person whose drinking is associated with certain features. Arguably the most important is the development of physical withdrawal features when the person is no longer drinking. What are these physical changes? Initially they comprise sweats, tremor, shakes, and pyrexia. They are probably mediated by the release of adrenal (from the adrenal glands situated just above the kidneys). There are other features too – a narrowing of the drinking repertoire towards strong (and cheap) sources of alcohol, a preoccupation with drinking related activity, craving for alcohol, and the relief of alcohol withdrawal symptoms by taking more alcohol.
An English and American wrote a well known scientific paper defining alcohol dependence (with the above features) – pointing out it is a medical syndrome – Griffith Edwards and Milton Gross – and these features are used in the two main psychiatric classifications (International Classification of Diseases (version 10) of the World Health Organization (UN) and the Diagnostic and Statistical Manual (version 4) of the American Psychiatric Association.)
What is the implication? Well one is that alcohol dependence is a physical condition like nicotine addiction and requires treatment as such, rather than a moral / judgemental approach. This may sound odd given the damage alcoholism causes the individual and their family and friends. However it is correct – alcohol dependence requires physical treatment, then more psychological management. Indeed the symptoms of alcohol withdrawal – that is the physical and mental effects - are so severe (and dangerous) in established alcohol dependence that the person should not stop abruptly, but gradually or with the help of “detoxification” medication.
While the early features of alcohol symptoms comprise those stated in the first paragraph above, with time there is an unfolding of progressively more severe (and adverse) symptoms – certainly enough to drive one back to drink. Indeed it seems that when the body has insufficient alcohol it produces withdrawal symptoms that perpetuate drinking as alcohol is the perfect remedy for them. This the drinker learns from experience and a pattern of 24 hour remedy drinking is established. Many alcohol dependent individuals, like smokers, do not actually enjoy their habit, and unlike the social drinker do not drink for the pleasure of inebriation – more to ward off or relief withdrawal symptoms.
And what are the further symptoms. First is stronger tremor and strong feelings of anxiety and restlessness. In the first 12 hours or so there is risk of a generalized epileptic seizure – a so-called “rum fit”. There may be double vision and incoordination. The blood pressure and heart rate rises. Mild to severe psychotic symptoms may manifest – typically paranoia with or without hallucinations. The hallucinations can be mild or “elemental” for example a sound or fleeting illusion, but may be fully formed and complex – for example in full consciousness seeing a rat on the bed. After 18 to 36 hours a more sinister development may occur – clouding of consciousness and the development of delirium – acute impairment of orientation in time and place and person, memory impairment, inattention and other features. In this state of delirium there is usually intense fear induced by the psychotic ideas and perceptions. By this time the individual may be behaving in an alarming fashion – responding in a restless, aggressive fashion. The state of arousal may be such that there is significant fluid loss and the hypertensive state may be replaced by hypotension and cardiovascular collapse.
The extent of the alcohol withdrawal syndrome is proportionate to the degree of alcohol dependence. Alcohol dependence is a dimensional quantity – that is there is a range of severities. It follows that at some point in the individual’s drinking career there is a crossover from heavy social or excessive drinking to mild alcohol dependence – the latter being heralded by the development of the alcohol dependence criteria above.
There is quite a lot more to alcohol dependence that will be discussed in other articles. A final point to introduce is the principle behind management. This is clear and simple – rather than exhort the “alcoholic” to stop drinking (which they can’t) or hide their drink (so precipitating alcohol withdrawal), the alcohol dependent individual has to be educated and guided to alcohol treatment services – the family doctor or local project being the first step.
See also - Reflections on Laugharne and Alcohol
See also - Why are the Rich, Famous, and Influential Inadvertently Disadvantaged when it comes to the Management of their Emotional Health?
An English and American wrote a well known scientific paper defining alcohol dependence (with the above features) – pointing out it is a medical syndrome – Griffith Edwards and Milton Gross – and these features are used in the two main psychiatric classifications (International Classification of Diseases (version 10) of the World Health Organization (UN) and the Diagnostic and Statistical Manual (version 4) of the American Psychiatric Association.)
What is the implication? Well one is that alcohol dependence is a physical condition like nicotine addiction and requires treatment as such, rather than a moral / judgemental approach. This may sound odd given the damage alcoholism causes the individual and their family and friends. However it is correct – alcohol dependence requires physical treatment, then more psychological management. Indeed the symptoms of alcohol withdrawal – that is the physical and mental effects - are so severe (and dangerous) in established alcohol dependence that the person should not stop abruptly, but gradually or with the help of “detoxification” medication.
While the early features of alcohol symptoms comprise those stated in the first paragraph above, with time there is an unfolding of progressively more severe (and adverse) symptoms – certainly enough to drive one back to drink. Indeed it seems that when the body has insufficient alcohol it produces withdrawal symptoms that perpetuate drinking as alcohol is the perfect remedy for them. This the drinker learns from experience and a pattern of 24 hour remedy drinking is established. Many alcohol dependent individuals, like smokers, do not actually enjoy their habit, and unlike the social drinker do not drink for the pleasure of inebriation – more to ward off or relief withdrawal symptoms.
And what are the further symptoms. First is stronger tremor and strong feelings of anxiety and restlessness. In the first 12 hours or so there is risk of a generalized epileptic seizure – a so-called “rum fit”. There may be double vision and incoordination. The blood pressure and heart rate rises. Mild to severe psychotic symptoms may manifest – typically paranoia with or without hallucinations. The hallucinations can be mild or “elemental” for example a sound or fleeting illusion, but may be fully formed and complex – for example in full consciousness seeing a rat on the bed. After 18 to 36 hours a more sinister development may occur – clouding of consciousness and the development of delirium – acute impairment of orientation in time and place and person, memory impairment, inattention and other features. In this state of delirium there is usually intense fear induced by the psychotic ideas and perceptions. By this time the individual may be behaving in an alarming fashion – responding in a restless, aggressive fashion. The state of arousal may be such that there is significant fluid loss and the hypertensive state may be replaced by hypotension and cardiovascular collapse.
The extent of the alcohol withdrawal syndrome is proportionate to the degree of alcohol dependence. Alcohol dependence is a dimensional quantity – that is there is a range of severities. It follows that at some point in the individual’s drinking career there is a crossover from heavy social or excessive drinking to mild alcohol dependence – the latter being heralded by the development of the alcohol dependence criteria above.
There is quite a lot more to alcohol dependence that will be discussed in other articles. A final point to introduce is the principle behind management. This is clear and simple – rather than exhort the “alcoholic” to stop drinking (which they can’t) or hide their drink (so precipitating alcohol withdrawal), the alcohol dependent individual has to be educated and guided to alcohol treatment services – the family doctor or local project being the first step.
See also - Reflections on Laugharne and Alcohol
See also - Why are the Rich, Famous, and Influential Inadvertently Disadvantaged when it comes to the Management of their Emotional Health?
posted by Dr Arthur Bostock at 2:00 AM
2 Comments:
I'm going to be going sober on 2/22/06. Wish me Luck. Daily updates on my progress and withdrawal will be posted at:
http://withdrawals.blogspot.com/
You have a funny blog. I thought this would help add value to it. Enjoy.
adhd diet
http://www.theadhdspecialist.com
Children with ADHD
There is a perplexing state of affairs in today's society, there lies a strong correlation between the affluence of a society and the amount of disease that is present. There is also another correlation that troubles many a people and that is with affluence comes disease at an Earlier age.
Working with children and the parents of these children I often get asked the question, 'Why are Children with ADHD on the increase?'
The answer as you shall find is one that is both interesting and challenging.
Children of today are really no more different from the children of yesterday in terms of genetic makeup. However, if you examine the issue more closely you will tend to find that many children today have been given labels. For example, 'Oh, those are children with ADHD' or 'Those are the children who can't sit still.' Or 'That is the kid that always gets into trouble.'
These labels are not only destructive but also become a self fulfilling prophecy as it is repeated adnauseum.
So as a 21st century parent or a parent with a child with ADHD or a parent with children with ADHD, what knowledge framework do you need to equip yourself with to ensure your children live out their true potential?
Here is a quick reference list for thinking about ADHD
� ADHD is a source of great frustration because it is misunderstood
� ADHD medications are a great short term time buying device and should be avoided long term
� The above point goes for any sort of drug consumption. Think about it for a minute. Unless you have a biochemical deficiency in your body like Type 1 diabetes where your body fails to produce enough insulin or any at all, why would you take an external drug? A body that is in balance is totally healthy. It is only when the body is out of balance that dis-ease symptoms start to creep up.
� ADHD is a biochemical imbalance of the mind and body.
� The Head of Psychiatry in Harvard states that drugs for ADHD simply mask the effects of ADHD. It does not cure ADHD. This is an important point because a cure implies never to have to take the medication. This means that once you start on medication you will have to be on it for the rest of your life i.e. you have medically acquired a dependency for a biochemical imbalance. That is like stuffing all your rubbish (problematic behaviors) into a closet (medication) where no one can see it. But if you continue to stuff more rubbish into that closet, one day you will not have enough space and need to do one of two things. You either empty the rubbish (the natural conclusion) or you get a bigger closet (i.e. change to stronger medication to control the symptoms). The choice is obvious but sometimes when you don't have the necessary tools to deal with ADHD you tend to think the bigger closet is the only option.
� ADHD children are super sensitive to the emotions around them. Often they pick up emotional cues from their parents without realizing. Many parents come home frustrated or annoyed from work, the child with ADHD picks this up and starts to 'cause trouble' by becoming restless. Parents frustration increase because they just want some peace and quiet. They get angry which in turn is picked up by the child who then intensifies their activity. Things get way out of hand and some sort of punishment is handed down to the child who has no idea what just happened. The cycle repeats itself every so often.
� Our brains are wired emotionally. Positive praise is interpreted as an analytical/thinking exercise. Negative criticism including scolding, name calling, physical punishment all go directly to the emotional brain of children with ADHD. This means in order to ensure you get your message across in the most optimal way, you need to learn how to communicate with your ADHD children the way they like to be communicated with.
� Every negative comment requires 16 positive comments to neutralize the emotion. Save yourself the frustration and agitation by practicing positive communication.
The list is by no means complete. In dealing with children with ADHD there are a certain set of behavioural principles to follow. I will detail these steps in the coming weeks. I'll also build on the list as you continue to learn about what appears to be a mystical disorder known as 'Children with ADHD'
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