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Alcohol Abuse

Disease Details

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Description: Alcohol abuse is a pattern of drinking that leads to significant distress or impairment, including failure to fulfill responsibilities, drinking in dangerous situations, legal problems, and continued drinking despite social or interpersonal issues.

One-sentence description: Alcohol abuse involves the excessive and harmful consumption of alcohol that results in failure to meet work, school, or home responsibilities, and can lead to various social, legal, and health problems.
Type: Alcohol abuse is not directly caused by a single gene, so it does not have a specific type of genetic transmission. However, it does have a heritable component, meaning that genetic factors can contribute to an individual's risk for developing alcohol abuse. Multiple genes and their interactions with environmental factors play a role in the susceptibility to alcohol abuse.
Signs And Symptoms: Individuals with an alcohol use disorder will often complain of difficulty with interpersonal relationships, problems at work or school, and legal problems. Additionally, people may complain of irritability and insomnia. Alcohol use disorder is also an important cause of chronic fatigue.
Signs of alcohol abuse are related to alcohol's effects on organ systems. However, while these findings are often present, they are not necessary to make a diagnosis of alcohol abuse. Alcohol use disorder causes acute central nervous system depression which leads to inebriation, euphoria, impulsivity, sedation and poor judgment. Chronic alcohol use may lead to dependence, reckless behavior, anxiety, irritability, and insomnia.
Alcohol is hepatotoxic and chronic use leads to elevated liver enzyme levels in the bloodstream (classically the aspartate aminotransferase level is at least twice as high as the alanine transaminase level), cirrhosis, and liver failure. Cirrhosis leads to an inability to process hormones and toxins and increased estrogen levels. The skin of a patient with alcoholic cirrhosis can feature spider angiomas, palmar erythema, and — in acute liver failure — jaundice and ascites. The derangements of the endocrine system may lead to the enlargement of the male breasts. The inability to process toxic metabolites such as ammonia in alcoholic cirrhosis may lead to hepatic encephalopathy. Chronic alcohol use is also associated with malnutrition, Wernicke-Korsakoff syndrome, alcoholic cardiomyopathy, hypertension, stroke, arrhythmias, pancreatitis, depression, and dementia. Alcohol is also an established carcinogen with chronic use associated with increased risk of cancer.Alcohol use disorder can result in brain damage which causes impairments in executive functioning such as impairments to working memory and visuospatial function. Alcohol abuse is also associated with incidence of personality disorders, affective disorders, and emotional dysregulation. Binge drinking is associated with individuals reporting fair to poor health compared to non-binge drinking individuals and which may progressively worsen over time. Alcohol also causes impairment in critical thinking, ability to handle stress, and attention. Alcoholism can cause significant impairment in social skills, due to the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area of the brain. The prefrontal cortex is responsible for cognitive functions such as working memory, impulse control, and decision making. This region of the brain is vulnerable to chronic alcohol-induced oxidative DNA damage. The social skills that can be impaired by alcohol abuse include impairments in perceiving facial emotions, difficulty with perceiving vocal emotions, theory of mind deficits, and ability to understand humor. Adolescent binge drinkers are most sensitive to damaging neurocognitive functions especially executive functions and memory. People who abuse alcohol are less likely to survive critical illness with a higher risk for having sepsis and increased risk of death during hospitalization. Cessation of alcohol use after dependence is formed may lead to alcohol withdrawal disorder and associated sequela including seizures, insomnia, anxiety, cravings, and delirium tremens.A smaller volume of consumed alcohol has a greater impact on the older adult than it does on a younger individual. As a result, the American Geriatrics Society recommends for an older adult with no known risk factors less than one drink a day or fewer than two drinks per occasion regardless of gender.
Prognosis: Alcohol abuse during adolescence, especially early adolescence (i.e. before age 15), may lead to long-term changes in the brain which leaves them at increased risk of alcoholism in later years; genetic factors also influence age of onset of alcohol abuse and risk of alcoholism. For example, about 40 percent of those who begin drinking alcohol before age 15 develop alcohol dependence in later life, whereas only 10 percent of those who did not begin drinking until 20 years or older developed an alcohol problem in later life. It is not entirely clear whether this association is causal, and some researchers have been known to disagree with this view.Alcohol use disorders often cause a wide range of cognitive impairments that result in significant impairment of the affected individual. If alcohol-induced neurotoxicity has occurred a period of abstinence for on average a year is required for the cognitive deficits of alcohol abuse to reverse.College/university students who are heavy binge drinkers (three or more times in the past two weeks) are 19 times more likely to be diagnosed with alcohol dependence, and 13 times more likely to be diagnosed with alcohol abuse compared to non-heavy episodic drinkers, though the direction of causality remains unclear. Occasional binge drinkers (one or two times in the past two weeks), were found to be four times more likely to be diagnosed with alcohol abuse or dependence compared to non-heavy episodic drinkers.
Onset: The onset of alcohol abuse can vary widely among individuals, but it often begins in late adolescence or early adulthood. Factors such as genetics, environmental influences, and social pressures can contribute to its development. Early signs may include an increasing tolerance to alcohol, frequent intoxication, and neglecting responsibilities or relationships due to drinking. Early intervention is key to preventing the progression to more severe forms of alcohol use disorder.
Prevalence: The prevalence of alcohol abuse can vary significantly by region and population. In the United States, approximately 6% of adults have an alcohol use disorder, according to the National Institute on Alcohol Abuse and Alcoholism. Globally, the World Health Organization estimates that about 2-3% of the population suffers from alcohol use disorders.
Epidemiology: Alcohol abuse is said to be most common in people aged between 15 and 24 years, according to Moreira 2009. However, this particular study of 7275 college students in England collected no comparative data from other age groups or countries.
Causes of alcohol abuse are complex and are likely the combination of many factors, from coping with stress to childhood development. The US Department of Health & Human Services identifies several factors influencing adolescent alcohol use, such as risk-taking, expectancies, sensitivity and tolerance, personality and psychiatric comorbidity, hereditary factors, and environmental aspects.Studies show that child maltreatment such as neglect, physical, and/or sexual abuse, as well as having parents with alcohol abuse problems, increases the likelihood of that child developing alcohol use disorders later in life. According to Shin, Edwards, Heeren, & Amodeo (2009), underage drinking is more prevalent among teens that experienced multiple types of childhood maltreatment regardless of parental alcohol abuse, putting them at a greater risk for alcohol use disorders. Genetic and environmental factors play a role in the development of alcohol use disorders, depending on age. The influence of genetic risk factors in developing alcohol use disorders increase with age ranging from 28% in adolescence and 58% in adults.
Intractability: Alcohol abuse is considered a chronic condition that can be challenging to manage, but it is not inherently intractable. With appropriate interventions such as behavioral therapy, medications, support groups, and lifestyle changes, many individuals can achieve and maintain sobriety. Success often requires a comprehensive, long-term approach and commitment to treatment.
Disease Severity: Alcohol abuse can lead to a range of severe health issues over time. Chronic alcohol abuse increases the risk of liver diseases like cirrhosis, cardiovascular problems, certain cancers, neurological damage, and mental health disorders such as depression and anxiety. It can also lead to social and legal problems and impair daily functioning and relationships. Early stages might involve less severe physical symptoms but can still have significant social and psychological impacts.
Healthcare Professionals: Disease Ontology ID - DOID:1574
Pathophysiology: Alcohol abuse involves the excessive consumption of alcohol, leading to various physiological and psychological effects. The pathophysiology includes:

1. Brain Chemistry: Alters neurotransmitter levels, particularly increasing gamma-aminobutyric acid (GABA) activity and reducing glutamate activity, leading to sedation and impaired cognitive functions.

2. Liver Damage: Chronic alcohol use can lead to fatty liver, hepatitis, and eventually cirrhosis due to the toxic effects of acetaldehyde, a metabolite of alcohol.

3. Cardiovascular System: Increases the risk for hypertension, cardiomyopathy, and arrhythmias due to direct toxic effects and elevated blood pressure.

4. Gastrointestinal Tract: Causes inflammation of the stomach lining (gastritis), pancreatitis, and malabsorption issues due to mucosal damage.

5. Metabolism: Disrupts lipid and glucose metabolism, potentially leading to conditions such as hyperlipidemia and diabetes.

6. Immune System: Weakens immune response, making the body more susceptible to infections.

Regular excessive alcohol consumption can lead to widespread organ damage and numerous health complications.
Carrier Status: Carrier status is not applicable to alcohol abuse.
Mechanism: Alcohol abuse primarily affects the central nervous system. The mechanism involves the disruption of neurotransmitter systems, particularly gamma-aminobutyric acid (GABA) and glutamate. Alcohol enhances the inhibitory effects of GABA, leading to sedation and anxiolytic effects, and inhibits the excitatory neurotransmitter glutamate, resulting in impaired cognitive and motor function.

On a molecular level, alcohol alters the function of various ion channels, neurotransmitter receptors, and signaling pathways. For instance, alcohol modulates GABA_A receptors and NMDA receptors, influencing synaptic transmission. Additionally, chronic alcohol exposure affects gene expression and can lead to neuroadaptive changes that contribute to tolerance, dependence, and withdrawal symptoms. It also increases oxidative stress, leading to damage in various tissues, and promotes inflammation, which can exacerbate organ damage over time.
Treatment: Treatment for alcohol abuse often involves a combination of behavioral therapies and support systems. Common approaches include:

1. **Detoxification**: Typically conducted under medical supervision to manage withdrawal symptoms.
2. **Counseling and Therapy**: Cognitive-behavioral therapy (CBT), motivational enhancement therapy, and family therapy are often used.
3. **Medication**: Drugs like disulfiram, naltrexone, and acamprosate can help reduce cravings and manage withdrawal symptoms.
4. **Support Groups**: Organizations such as Alcoholics Anonymous (AA) provide peer support and encourage abstinence.
5. **Rehabilitation Programs**: Inpatient or outpatient programs that offer structured treatment plans.
6. **Lifestyle Changes**: Adopting a healthy diet, regular exercise, and social support to maintain sobriety.

Consistency and a comprehensive approach are key for effective treatment.
Compassionate Use Treatment: For alcohol abuse, compassionate use treatments typically refer to therapies that are still experimental or not widely available but are provided to patients with serious conditions when no other treatments are effective. Off-label or experimental treatments for alcohol abuse may include:

1. **Naltrexone (Vivitrol, Revia):** While approved for alcohol dependence, it is sometimes used off-label in different dosages or delivery methods.

2. **Acamprosate (Campral):** Also approved for alcohol dependence but may be used in combination with other treatments off-label.

3. **Topiramate (Topamax):** Originally approved for epilepsy and migraines, it has shown promise in reducing alcohol cravings and consumption.

4. **Baclofen:** A muscle relaxant often used off-label to reduce alcohol cravings and withdrawal symptoms.

5. **Ondansetron (Zofran):** Primarily used for nausea, sometimes used off-label for its potential to reduce alcohol consumption, particularly in early-onset alcoholics.

6. **Gabapentin (Neurontin):** Approved for epilepsy and neuropathic pain, sometimes used off-label to alleviate withdrawal symptoms and cravings.

7. **Ketamine:** An anesthetic that has been investigated for its potential to aid in the treatment of alcohol dependence, though it is still experimental.

Access to these treatments typically requires close collaboration with a healthcare provider who can monitor for efficacy and safety.
Lifestyle Recommendations: For alcohol abuse, here are some lifestyle recommendations:

1. **Limit Alcohol Consumption**: Gradually reduce the amount of alcohol consumed to decrease dependence.
2. **Seek Support**: Join support groups such as Alcoholics Anonymous (AA) or seek counseling.
3. **Avoid Triggers**: Stay away from environments and situations that may encourage drinking.
4. **Healthy Lifestyle**: Engage in regular physical activity, maintain a balanced diet, and get adequate sleep.
5. **Stress Management**: Practice relaxation techniques like meditation, yoga, or deep-breathing exercises.
6. **Develop Hobbies**: Invest time in hobbies and activities that do not involve alcohol.
7. **Stay Hydrated**: Drink plenty of water to help your body recover.
8. **Set Goals**: Define clear, achievable goals for reducing alcohol consumption.
9. **Medical Consultation**: Consult a healthcare professional for personalized advice and possible medical treatments.
Medication: Medications for alcohol abuse typically include:

1. **Naltrexone**: It reduces cravings for alcohol and can help prevent relapse.
2. **Disulfiram**: It creates an unpleasant reaction when alcohol is consumed.
3. **Acamprosate**: It helps to stabilize chemical imbalances in the brain that may lead to alcohol dependence.
4. **Topiramate**: Sometimes used off-label to reduce drinking.
5. **Gabapentin**: Also used off-label to reduce withdrawal symptoms and cravings.

These medications are usually part of a comprehensive treatment plan that includes counseling and support.
Repurposable Drugs: There are several drugs that have been repurposed or are being explored for treating alcohol abuse. These include:

1. **Naltrexone** - Originally used to treat opioid addiction, it can help reduce the craving for alcohol.
2. **Disulfiram** - Initially used to treat parasitic infections, it causes adverse reactions when alcohol is consumed, discouraging drinking.
3. **Acamprosate** - While developed specifically for alcohol dependence, it's sometimes seen as a repurposed drug from its original use in treating brain chemistry disorders.
4. **Topiramate** - An anticonvulsant drug that has shown efficacy in reducing alcohol consumption.
5. **Baclofen** - A muscle relaxant, which can reduce alcohol cravings and withdrawal symptoms.
6. **Ondansetron** - Originally an anti-nausea medication, it has been studied for its potential to reduce alcohol consumption

These drugs can help manage alcohol dependence through various mechanisms, including reducing cravings, managing withdrawal symptoms, and creating aversive reactions to alcohol consumption.
Metabolites: Alcohol abuse leads to the production of several metabolites, primarily through the metabolism of ethanol in the liver. The primary metabolites are:

1. Acetaldehyde - formed by the action of the enzyme alcohol dehydrogenase (ADH).
2. Acetate - produced from acetaldehyde by the enzyme aldehyde dehydrogenase (ALDH).

Additionally, other byproducts and related compounds include ethyl glucuronide (EtG) and ethyl sulfate (EtS), which are often used as biomarkers to detect alcohol consumption.
Nutraceuticals: Nutraceuticals that may be beneficial in managing alcohol abuse include:

1. Omega-3 fatty acids: Found in fish oil, they may help reduce inflammation and improve mental health.
2. B vitamins: Alcohol abuse often leads to deficiencies, particularly in B1 (thiamine), B6 (pyridoxine), B9 (folate), and B12 (cobalamin).
3. N-acetylcysteine (NAC): An antioxidant that may help reduce alcohol cravings and support liver health.
4. Milk thistle: Contains silymarin, which may support liver function and detoxification.

Always consult with a healthcare provider before starting any new supplement regimen.
Peptides: Peptides related to alcohol abuse are being studied for their potential therapeutic roles. Some peptides, such as neuropeptide Y (NPY), play a role in modulating stress and anxiety, which can influence alcohol consumption and dependence. Research is ongoing to explore how targeting these peptides could help treat alcohol abuse.

"Nan" may refer to nanoparticles or nanotechnology, which are being explored for delivering drugs or therapies more effectively in the treatment of alcohol abuse. Nanotechnology could potentially improve the precision of how treatments are administered, minimizing side effects and enhancing efficacy.