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Alcoholism. AlcoholismAlcoholism is am addiction disease. It is widespread and serious disease, which exists in a modern world. Alcoholism brings consequences on physical, psychological, social and economical functioning of a person that consumes alcohol. Even if alcohol is being consumed for centuries, studying the harmful effects that alcohol causes started recently. In the beginning, alcoholism was not considered a disease, it was considered a vice. However, the World Health Organization declared alcoholism a disease in 1951, and the problem related to defining alcoholism appears. Defining alcoholism was difficult because the â€Å"alcoholism† includes variety of physical, psychological and social changes. Ayd defined alcoholism as a chronic disease with combined influence of genetic, psychosocial, and environmental factors, which have strong influence in the development of alcoholism and its manifestations. It is considered as a progressive disease, which can be fatal, and it can be characterized by reduced control over consummation of alcohol, high level of preoccupation with alcohol, usage of alcohol (despite consequences), and possible appearance of distortions in thinking (such as denial) (27). Alcoholism is a chronicle disease, characterized with persistent consummation of alcohol, even with the knowledge of harmful effect that it produces. It manifests as incapability of controlling the act of drinking, and as a time goes by the whole life of an alcoholic is subordinated to drinking. The drinking is conducted, usually, on a daily basis, and it can be common for an alcoholic to deny this craving, although they do not want to eliminate the alcohol from their life. DSM IV classification represents alcoholism as an illness that includes alcohol abuse and dependence, which can be episodic or continuous. Alcoholism can be viewed as use of alcohol in a quantity and a frequency, which causes significant physiological, psychological, sociological or occupational problems (Ayd, 21). World Health Organization presented the following definition of alcoholism: â€Å"A chronic behavioral disorder manifested by repeated drinking of alcoholic beverages in excess of the dietary and social uses of the community and to an extent that interferes with the drinker’s health or his social or economic functions† (Zimberg, 4.). Jellinek (via Zimberg) gave the classification of several types of alcoholism: â€Å"alpha alcoholism†, defined as an abuse of alcohol, which is used to relieve physical or psychological pain, without losing the ability to control the drinking, with no withdrawal symptoms and no significant progression of the disease. â₠¬Å"Beta alcoholism†, defined as an alcoholism that has no physical or psychological dependence; it can be progressive and can produce medical complications. â€Å"Gamma alcoholism† represents the type of alcoholism in which control over drinking does not exist, and it produces physical, psychological and social problems. â€Å"Delta alcoholism† is a type of alcoholism that produces physical, psychological and social problems, and the person that drinks has a potential possibility of abstaining from alcohol for some period. â€Å"Epsilon alcoholism† is described as a periodic binge drinking (4). Symptoms of alcoholism - There is no one symptom that could define the alcoholism. The symptoms of alcoholism can be diverse and can vary, mostly depending on the person that consumes alcohol.   Stimmel mentioned that the National Council on Alcoholism has developed a list of signs and symptoms for diagnosing alcoholism, and that they can be divided into two main groups: definitive and probable (103). According to National Council on Alcoholism (via Stimmel), definite symptoms are: physical dependency on alcohol, followed with tremor, hallucinations and seizures; changes in psychological functioning; influence of alcohol on a brain; complications caused by drinking alcohol; continuous drinking with no consideration to many medical contraindications; indiscriminate use of alcohol; alcoholic blackouts; blood alcohol level over the 0.15 -0.30 percent. Probable symptoms of alcoholism are: loss of control over drinking; repetitive drinking and/or morning drinking; repeated attempts to a chieve abstinence; excuses from work; denying alcoholism by changing the type of alcoholic beverage; lack of interest for activities that are not associated with consummation of alcohol; low ability to control the emotion of rage when drinking, possible suicidal thoughts when drinking; using of alcohol as a method to reduce insomnia, anger and depression (103). O'Neill and Sher have emphasized next group of symptoms: spending a lot of time during the day or night thinking about alcohol, neglecting obligation because of consummation of alcohol, being late or missing the school or work, feeling a strong need for a drink early in the morning, attempting to stop with drinking, and feeling dependent on alcohol. (496). Some other symptoms of alcoholism might be tolerance and withdrawal (with possible severe withdrawal symptoms - hallucinations or convulsions), reduction of the number of activities because of drinking, using alcohol in potentially dangerous situations (driving), and time spent drinking (the time spent to consume alcohol increases over time). As the time goes by, an alcoholic will have to drink more to achieve the same â€Å"effect† that alcohol provides, and there is a possibility to see them drinking alone, by themselves, and finding excuses for exaggerated drinking. Causes of alcoholism - The alcoholism is a disease, which is caused by interaction of multiple causes. Causes are often complex and they have become numerous during the time. Grant and Gwinner considered following factors as main factors which help development of alcohol dependence: biological (impact on central nervous system, metabolism of alcohol, sensitivity to alcohol), psychological (personality traits and attitudes), and socio-cultural factors (64). According to Gifford, the causes of alcoholism should be looked for in genetics, environment and neurology (29). Also, a person who has mood disorders (anxiety or depression) is at higher risk to become dependent from alcohol. Genetics: There are evidences that support the thesis of inherited predisposition to alcohol dependence (Gifford, 29). It can be manifested as person’s vulnerability to alcohol dependence, due to the functioning of opiate receptors and the functioning of a liver. However, having a parent that is dependent on alcohol does not mean that a person will become an alcoholic itself. Genetic predispositions combined with other groups of factors (such as environmental factors) might contribute to appearance of alcohol dependence. Environment: the influence of a family on person’s development can be seen in a behavior related to alcohol consumption. Children who have alcoholic parents are at four times higher risk of developing alcohol dependence than children whose parents do not consume alcohol (Gifford, 30). The contributing influence on alcohol drinking can be availability of alcohol, being surrounded with peers that consume alcohol, advertising of alcohol (making it attractive and desirable), conflicts at the work or in home, and the presence of a partner that consumes alcohol. Other authors summarize causes of alcohol dependence, and some of them are family influence, influence of a culture, and adult situation (McCord McCord, 150). Anthony et al. conducted a research that gave following results: males are more prone to develop alcohol dependence than women are (249). Person from age 25-34 years old are more prone to develop alcohol dependence (251). Lack of employment, low academic achievement can bring a risk of development of alcohol dependence (253). Neurology: abuse of alcohol causes changes in entire body, and it especially leaves harmful consequences to a sensitive tissue of the brain. The main consequences are related to disbalance of neurotransmitters. Consummation of alcohol can cause disbalance of chemicals in the brain tissue, and it can regulate, in some way, the chemical balance in the brain. Whenever this balance is disturbed the brain might cause the body to feel the need for alcohol, in order to keep the balance of chemicals in order, while, at the same time, brain gradually looses the ability to maintain the balance on its own (Gifford, 30). Impacts of alcoholism - Alcohol consumption leads towards many complications, which can be general and long term, and can involve every aspect of a person’s life. Impact of alcoholism can be seen in health condition, psychological functioning, and socio-cultural aspect of a person’s life. According to Gifford, the most common health problems related to alcohol dependency are: problems with endocrine system (liver-alcoholic hepatitis, cirrhosis, which produces secondary effects: vitamin deficiency, decreased absorption of fat, damages in cell structure, low blood sugar, etc. (32, 33), pancreas-diabetes), and digestive system (damage of intestine’s walls (can cause bleeding), reducing the amount of digestive enzymes (34)). There are significant problems with cardiovascular system (blood-appearance of anemia, blood clots, suppressing of the immune system, problems with creation of platelet, heart-high blood pressure, heart attack, stroke, coronary artery disease, myocarditis, alcoholic cardiomyopathy, arrhythmia (34, 35)). Sexual related problems include practicing sex without any protection (pregnancy and sexually transmitted diseases), and the appearance of problems with sexual performance in males. Alcohol can influence on women’s pregnancy and cause fetal alcohol syndrome and numerous defects on a fetus, if a mother continues to drink during the pregnancy (36). Impact of alcohol on a nervous system is manifested on brain (disbalance of neurotransmitters and tissue degeneration. Some of the problems that can occur are amnesia, dementia, abstinence syndrome and Wernicke-Korsakoff syndrome (35, 36)) and damages of nerves (peripheral neuropathy (36)). Alcohol can contribute to problems with respiratory system: lung infections (pneumonia, tuberculosis) and possible lung scarring (36). Impact on psychological life can be seen in appearance of depression and suicidal thoughts, anxiety, possible visual and auditory hallucinations (Spielberger, 126). Social complications are related to drunk driving, worse performance at work or at school, and relationship problems (Gifford, 39). Treatment of alcoholism – because alcohol dependency is a complex disease with various types of alcohol users, and numerous causes, the treatment of this disease should use the combination of multiple types of therapy. The most common therapy is based on a combination of psychological (â€Å"12 step facilitation†, group therapy-Alcoholic Anonymous (AA), â€Å"controlled drinking† (Spielberger, 126)), and pharmaceutical therapy (such as using of naltrexone). The behavioral therapy is being used in a combination with pharmacotherapy, because psychological treatment is, sometimes, not effective for all patients (Galanter, 4). The following statistic gives insight into the severity of the alcoholism as a social problem: 14 million people in the U.S.A. are alcohol dependent. 66% of the U.S.A. population consumes alcohol. 9.8 million men and 3.9 million women abuse alcohol or they think they are alcohol-dependent. 41% of all traffic fatalities in U.S.A. are caused by drinking alcohol. Approximately 43% of U.S.A. adults have had a child, parent, sibling or spouse who is dependent on alcohol, or was dependent on alcohol† (citation is retrieved from the internet site1). Ayd, Frank J. Lexicon of psychiatry, neurology, and the neurosciences. Lippincott Williams Wilkins, 2000 Anthony, James C. , Warner, Lynn A., Kessler, Ronald C. Comparative Epidemiology of Dependence on Tobacco, Alcohol, Controlled Substances, and Inhalants: Basic Findings From the National Comorbidity Survey. Experimental and Clinical Psychopharmacology. 1994. Vol. 2, No. 3, 244-268 Galanter, Marc. Research on alcoholism treatment: methodology, psychosocial treatment, selected treatment topics, research priorities. Springer, 2003 Gifford, Maria. Alcoholism. ABC-CLIO, 2009 Grant, Marcus, Gwinner, Paul. Alcoholism in perspective. Taylor Francis, 1979 McCord, William Maxwell, McCord, Joan. Origins of alcoholism. Stanford University Press, 1960 O'Neill, Susan E., Sher, Kenneth J. Physiological Alcohol Dependence Symptoms in Early Adulthood:A Longitudinal Perspective. Experimental and Clinical Psychopharmacology. 2000, Vol. 8, No. 4, 493-508 Spielberger, Charles D. Encyclopedia of applied psychology, Volume 1. Academic Press, 2004 Stimmel, Barry. Alcoholism, drug addiction, and the road to recovery: life on the edge. Routledge, 2002 Zimberg, Sheldon. The clinical management of alcoholism. Psychology Press, 1982