Alcoholism

Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal.[1] Problematic alcohol use has been mentioned in the earliest historical records. The World Health Organization (WHO) estimated there were 283 million people with alcohol use disorders worldwide as of 2016[update].[2][3] The term alcoholism was first coined in 1852,[4] but alcoholism and alcoholic are considered stigmatizing and likely to discourage seeking treatment, so diagnostic terms such as alcohol use disorder and alcohol dependence are often used instead in a clinical context.[5][6][7] Other terms, some slurs and some informal, have been used to refer to people affected by alcoholism such as tippler, sot, drunk, drunkard, dipsomaniac and souse.[8]

Alcohol is addictive, and heavy long-term use results in many negative health and social consequences. It can damage all organ systems, but especially affects the brain, heart, liver, pancreas, and immune system.[9][10] Heavy usage can result in trouble sleeping, and severe cognitive issues like dementia, brain damage, or Wernicke–Korsakoff syndrome. Physical effects include irregular heartbeat, impaired immune response, cirrhosis, increased cancer risk, and severe withdrawal symptoms if stopped suddenly.[9][10][11]

These effects can reduce life expectancy by 10 years.[12] Drinking during pregnancy may harm the child's health,[13] and drunk driving increases the risk of traffic accidents. Alcoholism is associated with violent and non-violent crime.[14] While alcoholism directly resulted in 139,000 deaths worldwide in 2013,[15] in 2012 3.3 million deaths may be attributable globally to alcohol.[16]

The development of alcoholism is attributed to environment and genetics equally.[9] Someone with a parent or sibling with an alcohol use disorder is 3-4 times more likely to develop alcohol use disorder, but only a minority do.[9] Environmental factors include social, cultural and behavioral influences.[17] High stress levels and anxiety, as well as alcohol's low cost and easy accessibility, increase the risk.[9][18] Medically, alcoholism is considered both a physical and mental illness.[19][20] Questionnaires are usually used to detect possible alcoholism.[9][21] Further information is then collected to confirm the diagnosis.[9]

Treatment takes several forms.[22] Due to medical problems that can occur during withdrawal, alcohol cessation should often be controlled carefully.[22] A common method involves the use of benzodiazepine medications.[22] The medications acamprosate or disulfiram may also be used to help prevent further drinking.[23] Mental illness or other addictions may complicate treatment.[24] Individual, group therapy, or support groups are used to attempt to keep a person from returning to alcoholism.[25][26] Among them is the abstinence-based mutual aid fellowship Alcoholics Anonymous (AA). A 2020 scientific review found clinical interventions encouraging increased participation in AA (AA/twelve step facilitation (TSF)) resulted in higher abstinence rates over other clinical interventions, and most studies found AA/TSF led to lower health costs.[lower-alpha 1][28][29][30]

## Contents

* 1 Signs and symptoms
* 1.1 Long-term misuse
* 1.2 Warning signs
* 1.2.1 Physical
* 1.2.1.1 Short-term effects
* 1.2.1.2 Long-term effects
* 1.2.2 Psychiatric
* 1.2.3 Social effects
* 1.3 Alcohol withdrawal
* 2 Causes
* 2.1 Availability
* 2.2 Gender difference
* 2.3 Genetic variation
* 2.4 DNA damage
* 3 Diagnosis
* 3.1 Definition
* 3.1.1 Alcoholism
* 3.1.2 DSM and ICD
* 3.2 Social barriers
* 3.3 Screening
* 3.4 Urine and blood tests
* 4 Prevention
* 5 Management
* 5.1 Cessation of alcohol intake
* 5.2 Psychological
* 5.3 Moderate drinking
* 5.4 Medications
* 6 Research
* 6.1 Dual addictions and dependencies
* 7 Epidemiology
* 8 Prognosis
* 9 History
* 10 Evolution
* 10.1 Overview
* 10.2 Fermented fruit consumption
* 10.3 Ancestral ethanol consumption
* 10.4 Hormetic effect
* 10.5 Humans frugivory
* 10.6 Modern alcoholism
* 11 Society and culture
* 12 See also
* 13 Notes
* 14 References
* 15 External links

## Signs and symptoms

The risk of alcohol dependence begins at low levels of drinking and increases directly with both the volume of alcohol consumed and a pattern of drinking larger amounts on an occasion, to the point of intoxication, which is sometimes called binge drinking. Binge drinking is the most common pattern of alcoholism. It has different definitions and one of this defines it as a pattern of drinking when a male has five or more drinks on an occasion or a female has at least four drinks on an occasion.[31]

### Long-term misuse

Some of the possible long-term effects of ethanol an individual may develop. Additionally, in pregnant women, alcohol can cause fetal alcohol syndrome.

Alcoholism is characterized by an increased tolerance to alcohol – which means that an individual can consume more alcohol –and physical dependence on alcohol, which makes it hard for an individual to control their consumption. The physical dependency caused by alcohol can lead to an affected individual having a very strong urge to drink alcohol. These characteristics play a role in decreasing the ability to stop drinking of an individual with an alcohol use disorder.[32] Alcoholism can have adverse effects on mental health, contributing to psychiatric disorders and increasing the risk of suicide. A depressed mood is a common symptom of heavy alcohol drinkers.[33][34]

### Warning signs

Warning signs of alcoholism include the consumption of increasing amounts of alcohol and frequent intoxication, preoccupation with drinking to the exclusion of other activities, promises to quit drinking and failure to keep those promises, the inability to remember what was said or done while drinking (colloquially known as "blackouts"), personality changes associated with drinking, denial or the making of excuses for drinking, the refusal to admit excessive drinking, dysfunction or other problems at work or school, the loss of interest in personal appearance or hygiene, marital and economic problems, and other symptoms such as loss of appetite, respiratory infections, or increased anxiety.[35]

#### Physical

##### Short-term effects

Drinking enough to cause a blood alcohol concentration (BAC) of 0.03–0.12% typically causes an overall improvement in mood and possible euphoria (intense feelings of well-being and happiness), increased self-confidence and sociability,[36] decreased anxiety,[37] and impaired judgment and fine muscle coordination. A BAC of 0.09% to 0.25% causes lethargy, sedation, balance problems and blurred vision. A BAC of 0.18% to 0.30% causes profound confusion, impaired speech (e.g. slurred speech), staggering, and vomiting. A BAC from 0.25% to 0.40% causes stupor, unconsciousness, amnesia, vomiting (death may occur due to inhalation of vomit while unconscious) and respiratory depression (potentially life-threatening). A BAC from 0.35% to 0.80% causes a coma (unconsciousness), life-threatening respiratory depression and possibly fatal alcohol poisoning.[36][38][37] With all alcoholic beverages, drinking while driving, operating an aircraft or heavy machinery increases the risk of an accident; virtually all countries have penalties for drunk driving.[39]

##### Long-term effects

In 2023, the World Health Organization stated that no level of alcohol consumption is safe, and even low or moderate consumption may cause harms to someone's health, including an increased risk of many cancers.[40] Having more than one drink a day for women or two drinks for men increases the risk of heart disease, high blood pressure, atrial fibrillation, and stroke.[41] Risk is greater with binge drinking, which may also result in violence or accidents. Globally, about 3.3 million deaths (5.9% of all deaths) are believed to be due to alcohol each year.[16] Alcoholism reduces a person's life expectancy by around ten years[12] and alcohol use is the third leading cause of early death in the United States.[41] Long-term alcohol misuse can cause a number of physical symptoms, including cirrhosis of the liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, nutritional deficiencies, peptic ulcers[42] and sexual dysfunction, and can eventually be fatal. Other physical effects include an increased risk of developing cardiovascular disease, malabsorption, alcoholic liver disease, and several cancers such as breast cancer and head and neck cancer.[43] Damage to the central nervous system and peripheral nervous system can occur from sustained alcohol consumption.[44][45] A wide range of immunologic defects can result and there may be a generalized skeletal fragility, in addition to a recognized tendency to accidental injury, resulting in a propensity for bone fractures.[46]

Women develop long-term complications of alcohol dependence more rapidly than do men; women also have a higher mortality rate from alcoholism than men.[47] Examples of long-term complications include brain, heart, and liver damage[48] and an increased risk of breast cancer. Additionally, heavy drinking over time has been found to have a negative effect on reproductive functioning in women. This results in reproductive dysfunction such as anovulation, decreased ovarian mass, problems or irregularity of the menstrual cycle, and early menopause.[47] Alcoholic ketoacidosis can occur in individuals who chronically misuse alcohol and have a recent history of binge drinking.[49][50] The amount of alcohol that can be biologically processed and its effects differ between sexes. Equal dosages of alcohol consumed by men and women generally result in women having higher blood alcohol concentrations (BACs), since women generally have a lower weight and higher percentage of body fat and therefore a lower volume of distribution for alcohol than men.[51]

#### Psychiatric

Long-term misuse of alcohol can cause a wide range of mental health problems. Severe cognitive problems are common; approximately 10% of all dementia cases are related to alcohol consumption, making it the second leading cause of dementia.[52] Excessive alcohol use causes damage to brain function, and psychological health can be increasingly affected over time.[53] Social skills are significantly impaired in people with alcoholism due to the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area of the brain. The social skills that are impaired by alcohol use disorder include impairments in perceiving facial emotions, prosody, perception problems, and theory of mind deficits; the ability to understand humor is also impaired in people who misuse alcohol.[54] Psychiatric disorders are common in people with alcohol use disorders, with as many as 25% also having severe psychiatric disturbances. The most prevalent psychiatric symptoms are anxiety and depression disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued abstinence.[55] Psychosis, confusion, and organic brain syndrome may be caused by alcohol misuse, which can lead to a misdiagnosis such as schizophrenia.[56] Panic disorder can develop or worsen as a direct result of long-term alcohol misuse.[57][58]

The co-occurrence of major depressive disorder and alcoholism is well documented.[59][60][61] Among those with comorbid occurrences, a distinction is commonly made between depressive episodes that remit with alcohol abstinence ("substance-induced"), and depressive episodes that are primary and do not remit with abstinence ("independent" episodes).[62][63][64] Additional use of other drugs may increase the risk of depression.[65] Psychiatric disorders differ depending on gender. Women who have alcohol-use disorders often have a co-occurring psychiatric diagnosis such as major depression, anxiety, panic disorder, bulimia, post-traumatic stress disorder (PTSD), or borderline personality disorder. Men with alcohol-use disorders more often have a co-occurring diagnosis of narcissistic or antisocial personality disorder, bipolar disorder, schizophrenia, impulse disorders or attention deficit/hyperactivity disorder (ADHD).[66] Women with alcohol use disorder are more likely to experience physical or sexual assault, abuse, and domestic violence than women in the general population,[66] which can lead to higher instances of psychiatric disorders and greater dependence on alcohol.[67]

#### Social effects

See also: Medicine:Drug-related crime

Serious social problems arise from alcohol use disorder due to the pathological changes in the brain and the intoxicating effects of alcohol.[52][68] Alcohol misuse is associated with an increased risk of committing criminal offences, including child abuse, domestic violence, rape, burglary and assault.[69] Alcoholism is associated with loss of employment,[70] which can lead to financial problems. Drinking at inappropriate times and behavior caused by reduced judgment can lead to legal consequences, such as criminal charges for drunk driving[71] or public disorder, or civil penalties for tortious behavior. An alcoholic's behavior and mental impairment while drunk can profoundly affect those surrounding the user and lead to isolation from family and friends. This isolation can lead to marital conflict and divorce, or contribute to domestic violence. Alcoholism can also lead to child neglect, with subsequent lasting damage to the emotional development of children of people with alcohol use disorders.[72] For this reason, children of people with alcohol use disorders can develop a number of emotional problems. For example, they can become afraid of their parents, because of their unstable mood behaviors. They may develop shame over their inadequacy to liberate their parents from alcoholism and, as a result of this, may develop self-image problems, which can lead to depression.[73]

### Alcohol withdrawal

Main article: Medicine:Alcohol withdrawal syndrome

"The bottle has done its work". Reproduction of an etching by G. Cruikshank, 1847.

As with similar substances with a sedative-hypnotic mechanism, such as barbiturates and benzodiazepines, withdrawal from alcohol dependence can be fatal if it is not properly managed.[68][74] Alcohol's primary effect is the increase in stimulation of the GABAA receptor, promoting central nervous system depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in tolerance and physical dependence. When alcohol consumption is stopped too abruptly, the person's nervous system experiences uncontrolled synapse firing. This can result in symptoms that include anxiety, upset stomach or nausea,[75] life-threatening seizures, delirium tremens, hallucinations, shakes and possible heart failure.[76][77] Other neurotransmitter systems are also involved, especially dopamine, NMDA and glutamate.[32][78]

Severe acute withdrawal symptoms such as delirium tremens and seizures rarely occur after 1-week post cessation of alcohol. The acute withdrawal phase can be defined as lasting between one and three weeks. In the period of 3–6 weeks following cessation, anxiety, depression, fatigue, and sleep disturbance are common.[79] Similar post-acute withdrawal symptoms have also been observed in animal models of alcohol dependence and withdrawal.[80]

A kindling effect also occurs in people with alcohol use disorders whereby each subsequent withdrawal syndrome is more severe than the previous withdrawal episode; this is due to neuroadaptations which occur as a result of periods of abstinence followed by re-exposure to alcohol. Individuals who have had multiple withdrawal episodes are more likely to develop seizures and experience more severe anxiety during withdrawal from alcohol than alcohol-dependent individuals without a history of past alcohol withdrawal episodes. The kindling effect leads to persistent functional changes in brain neural circuits as well as to gene expression.[81] Kindling also results in the intensification of psychological symptoms of alcohol withdrawal.[79] There are decision tools and questionnaires that help guide physicians in evaluating alcohol withdrawal. For example, the CIWA-Ar objectifies alcohol withdrawal symptoms in order to guide therapy decisions which allows for an efficient interview while at the same time retaining clinical usefulness, validity, and reliability, ensuring proper care for withdrawal patients, who can be in danger of death.[82]

## Causes

From the 1970s, addiction is described with the triangle: drug/individual/environment. These three key factors influence alcohol use: the drug (type, strength, availability, etc.), the individual (age, genetics, personality, etc.) and the environment (relatives, poverty, social norms, drug policy, etc.). Mental health as a risk factor for alcohol dependence or abuse William Hogarth's Gin Lane, 1751

A complex combination of genetic and environmental factors influences the risk of the development of alcoholism.[83] Genes that influence the metabolism of alcohol also influence the risk of alcoholism, as can a family history of alcoholism.[84] There is compelling evidence that alcohol use at an early age may influence the expression of genes which increase the risk of alcohol dependence. These genetic and epigenetic results are regarded as consistent with large longitudinal population studies finding that the younger the age of drinking onset, the greater the prevalence of lifetime alcohol dependence.[85][86]

Severe childhood trauma is also associated with a general increase in the risk of drug dependency.[83] Lack of peer and family support is associated with an increased risk of alcoholism developing.[83] Genetics and adolescence are associated with an increased sensitivity to the neurotoxic effects of chronic alcohol misuse. Cortical degeneration due to the neurotoxic effects increases impulsive behaviour, which may contribute to the development, persistence and severity of alcohol use disorders. There is evidence that with abstinence, there is a reversal of at least some of the alcohol induced central nervous system damage.[87] The use of cannabis was associated with later problems with alcohol use.[88] Alcohol use was associated with an increased probability of later use of tobacco and illegal drugs such as cannabis.[89]

### Availability

Alcohol is the most available, widely consumed, and widely misused recreational drug. Beer alone is the world's most widely consumed[90] alcoholic beverage; it is the third-most popular drink overall, after water and tea.[91] It is thought by some to be the oldest fermented beverage.[92][93][94][95]

### Gender difference

Comparison of prevalence of alcohol use disorders by gender and country (top image: female, bottom image: male)

World map colored by alcohol use disorders (15+), 12 month prevalence (%), data: WHO (2016)

0.0–3.6  3.7–7.3  7.4–11.0

11.1–14.7  14.8–18.1  19.9–21.2

22.2–23.5  28.8–28.8  33.9–36.9

Based on combined data in the US from SAMHSA's 2004–2005 National Surveys on Drug Use & Health, the rate of past-year alcohol dependence or misuse among persons aged 12 or older varied by level of alcohol use: 44.7% of past month heavy drinkers, 18.5% binge drinkers, 3.8% past month non-binge drinkers, and 1.3% of those who did not drink alcohol in the past month met the criteria for alcohol dependence or misuse in the past year. Males had higher rates than females for all measures of drinking in the past month: any alcohol use (57.5% vs. 45%), binge drinking (30.8% vs. 15.1%), and heavy alcohol use (10.5% vs. 3.3%), and males were twice as likely as females to have met the criteria for alcohol dependence or misuse in the past year (10.5% vs. 5.1%).[96] However, because females generally weigh less than males, have more fat and less water in their bodies, and metabolize less alcohol in their esophagus and stomach, they are likely to develop higher blood alcohol levels per drink. Women may also be more vulnerable to liver disease.[97]

### Genetic variation

There are genetic variations that affect the risk for alcoholism.[84][83][98][99] Some of these variations are more common in individuals with ancestry from certain areas; for example, Africa, East Asia, the Middle East and Europe. The variants with strongest effect are in genes that encode the main enzymes of alcohol metabolism, ADH1B and ALDH2.[84][98][99] These genetic factors influence the rate at which alcohol and its initial metabolic product, acetaldehyde, are metabolized.[84] They are found at different frequencies in people from different parts of the world.[100][84][101] The alcohol dehydrogenase allele ADH1B*2 causes a more rapid metabolism of alcohol to acetaldehyde, and reduces risk for alcoholism;[84] it is most common in individuals from East Asia and the Middle East. The alcohol dehydrogenase allele ADH1B*3 also causes a more rapid metabolism of alcohol. The allele ADH1B*3 is only found in some individuals of African descent and certain Native American tribes. African Americans and Native Americans with this allele have a reduced risk of developing alcoholism.[84][101][102] Native Americans, however, have a significantly higher rate of alcoholism than average; risk factors such as cultural environmental effects (e.g. trauma) have been proposed to explain the higher rates.[103][104] The aldehyde dehydrogenase allele ALDH2*2 greatly reduces the rate at which acetaldehyde, the initial product of alcohol metabolism, is removed by conversion to acetate; it greatly reduces the risk for alcoholism.[84][100]

A genome-wide association study (GWAS) of more than 100,000 human individuals identified variants of the gene KLB, which encodes the transmembrane protein β-Klotho, as highly associated with alcohol consumption. The protein β-Klotho is an essential element in cell surface receptors for hormones involved in modulation of appetites for simple sugars and alcohol.[105] Several large GWAS have found differences in the genetics of alcohol consumption and alcohol dependence, although the two are to some degree related.[98][99][106]

### DNA damage

Alcohol-induced DNA damage, when not properly repaired, may have a key role in the neurotoxicity induced by alcohol.[107] Metabolic conversion of ethanol to acetaldehyde can occur in the brain and the neurotoxic effects of ethanol appear to be associated with acetaldehyde induced DNA damages including DNA adducts and crosslinks.[107] In addition to acetaldehyde, alcohol metabolism produces potentially genotoxic reactive oxygen species, which have been demonstrated to cause oxidative DNA damage.[107]

## Diagnosis

### Definition

A man drinking from a bottle of liquor while sitting on a boardwalk, c. 1905–1914. Picture by Austrian photographer Emil Mayer.

Because there is disagreement on the definition of the word alcoholism, it is not a recognized diagnosis, and the use of the term alcoholism is discouraged due to its heavily stigmatized connotations.[5][6] It is classified as alcohol use disorder[108] in the DSM-5[9] or alcohol dependence in the ICD-11.[109] In 1979, the World Health Organization discouraged the use of alcoholism due to its inexact meaning, preferring alcohol dependence syndrome.[110]

Misuse, problem use, abuse, and heavy use of alcohol refer to improper use of alcohol, which may cause physical, social, or moral harm to the drinker.[111] The Dietary Guidelines for Americans, issued by the United States Department of Agriculture (USDA) in 2005, defines "moderate use" as no more than two alcoholic beverages a day for men and no more than one alcoholic beverage a day for women.[112] The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as the amount of alcohol leading to a blood alcohol content (BAC) of 0.08, which, for most adults, would be reached by consuming five drinks for men or four for women over a two-hour period. According to the NIAAA, men may be at risk for alcohol-related problems if their alcohol consumption exceeds 14 standard drinks per week or 4 drinks per day, and women may be at risk if they have more than 7 standard drinks per week or 3 drinks per day. It defines a standard drink as one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits.[113] Despite this risk, a 2014 report in the National Survey on Drug Use and Health found that only 10% of either "heavy drinkers" or "binge drinkers" defined according to the above criteria also met the criteria for alcohol dependence, while only 1.3% of non-binge drinkers met the criteria. An inference drawn from this study is that evidence-based policy strategies and clinical preventive services may effectively reduce binge drinking without requiring addiction treatment in most cases.[114]

#### Alcoholism

The term alcoholism is commonly used amongst laypeople, but the word is poorly defined. Despite the imprecision inherent in the term, there have been attempts to define how the word alcoholism should be interpreted when encountered. In 1992, it was defined by the National Council on Alcoholism and Drug Dependence (NCADD) and ASAM as "a primary, chronic disease characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking."[115] MeSH has had an entry for alcoholism since 1999, and references the 1992 definition.[116]

The WHO calls alcoholism "a term of long-standing use and variable meaning", and use of the term was disfavored by a 1979 WHO expert committee.[117]

In professional and research contexts, the term alcoholism is not currently favored, but rather alcohol abuse, alcohol dependence, or alcohol use disorder are used.[9][108] Talbot (1989) observes that alcoholism in the classical disease model follows a progressive course: if people continue to drink, their condition will worsen. This will lead to harmful consequences in their lives, physically, mentally, emotionally, and socially.[118] Johnson (1980) proposed that the emotional progression of the addicted people's response to alcohol has four phases. The first two are considered "normal" drinking and the last two are viewed as "typical" alcoholic drinking.[118]

#### DSM and ICD

In the United States, the Diagnostic and Statistical Manual of Mental Disorders (DSM) is the most common diagnostic guide for mental disorders,[119] whereas most countries use the International Classification of Diseases (ICD) for administrative and diagnostic purposes.[120] The two manuals use similar but not identical nomenclature to classify alcohol problems.

Manual  | Nomenclature  | Definition

|
|

DSM-IV | Alcohol abuse, or Alcohol dependence  |

* Alcohol abuse – repeated use despite recurrent adverse consequences.[121]
* Alcohol dependence – alcohol abuse combined with tolerance, withdrawal, and an uncontrollable drive to drink.[121] The term "alcoholism" was split into "alcohol abuse" and "alcohol dependence" in 1980's DSM-III, and in 1987's DSM-III-R behavioral symptoms were moved from "abuse" to "dependence".[122] Some scholars suggested that DSM-5 merges alcohol abuse and alcohol dependence into a single new entry,[123] named "alcohol-use disorder".[124]

DSM-5  | Alcohol use disorder  | "A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by [two or more symptoms out of a total of 12], occurring within a 12-month period ...."[125]
ICD-10 | Alcohol harmful use, or Alcohol dependence syndrome  | Definitions are similar to that of the DSM-IV. The World Health Organization uses the term "alcohol dependence syndrome" rather than alcoholism.[110] The concept of "harmful use" (as opposed to "abuse") was introduced in 1992's ICD-10 to minimize underreporting of damage in the absence of dependence.[122] The term "alcoholism" was removed from ICD between ICD-8/ICDA-8 and ICD-9.[126]
ICD-11 | Episode of harmful use of alcohol, Harmful pattern of use of alcohol, or Alcohol dependence  |

* Episode of harmful use of alcohol – "A single episode of use of alcohol that has caused damage to a person's physical or mental health or has resulted in behaviour leading to harm to the health of others ..."[127]
* Harmful pattern of use of alcohol – "A pattern of alcohol use that has caused damage to a person's physical or mental health or has resulted in behaviour leading to harm to the health of others ..."[128]
* Alcohol dependence – "Alcohol dependence is a disorder of regulation of alcohol use arising from repeated or continuous use of alcohol. The characteristic feature is a strong internal drive to use alcohol. ... The features of dependence are usually evident over a period of at least 12 months but the diagnosis may be made if alcohol use is continuous (daily or almost daily) for at least 1 month."[129]

### Social barriers

Attitudes and social stereotypes can create barriers to the detection and treatment of alcohol use disorder. This is more of a barrier for women than men. Fear of stigmatization may lead women to deny that they have a medical condition, to hide their drinking, and to drink alone. This pattern, in turn, leads family, physicians, and others to be less likely to suspect that a woman they know has alcohol use disorder.[47] In contrast, reduced fear of stigma may lead men to admit that they are having a medical condition, to display their drinking publicly, and to drink in groups. This pattern, in turn, leads family, physicians, and others to be more likely to suspect that a man they know is someone with an alcohol use disorder.[66]

### Screening

Screening for alcohol misuse is recommended among those over the age of 18, the screening interval is not well established.[130][131][132] Some national organizations recommend screening adolescents 12 years and older.[133] Several tools may be used to detect a loss of control of alcohol use. These tools are mostly self-reports in questionnaire form. Another common theme is a score or tally that sums up the general severity of alcohol use.[134] Online or written questionnaires have greater sensitivity for identifying unhealthy alcohol use compared to in-person questions asked by a healthcare worker.[132]

The CAGE questionnaire, named for its four questions, is one such example that may be used to screen patients quickly in a doctor's office.

> Two "yes" responses indicate that the respondent should be investigated further.

> The questionnaire asks the following questions:

>   1. Have you ever felt you needed to cut down on your drinking?
>   2. Have people annoyed you by criticizing your drinking?
>   3. Have you ever felt guilty about drinking?
>   4. Have you ever felt you needed a drink first thing in the morning (eye-opener) to steady your nerves or to get rid of a hangover?[135][136]

The CAGE questionnaire has demonstrated a high effectiveness in detecting alcohol-related problems; however, it has limitations in people with less severe alcohol-related problems, white women and college students.[137]

Other tests are sometimes used for the detection of alcohol dependence, such as the Alcohol Dependence Data Questionnaire, which is a more sensitive diagnostic test than the CAGE questionnaire. It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol use.[138] The Michigan Alcohol Screening Test (MAST) is a screening tool for alcoholism widely used by courts to determine the appropriate sentencing for people convicted of alcohol-related offenses,[139] driving under the influence being the most common. The Alcohol Use Disorders Identification Test (AUDIT), a screening questionnaire developed by the World Health Organization, is unique in that it has been validated in six countries and is used internationally. Like the CAGE questionnaire, it uses a simple set of questions – a high score requiring a deeper investigation.[140] The AUDIT questionnaire has a sensitivity of 73-100% for detecting unhealthy alcohol use, however the specificity is low.[132] The Paddington Alcohol Test (PAT) was designed to screen for alcohol-related problems amongst those attending Accident and Emergency departments. It concords well with the AUDIT questionnaire but is administered in a fifth of the time.[141]

### Urine and blood tests

Alcohol use is generally measured by self-reporting, but in clinical settings biomarkers are recommended. Various biological markers are used to assess chronic or recent use of alcohol, one common test being that of blood alcohol content (BAC).[142] Monitoring levels of gamma-glutamyl transpeptidase (GGT) is sometimes used to assess continued alcohol intake. But levels of GGT are elevated in only half of men with alcohol use disorder, and it is less commonly elevated in women and younger people.[143] GGT levels remain persistently elevated for many weeks with continued drinking, with a half life of 2–3 weeks, making the GGT level a useful assessment of continued and chronic alcohol use.[143] However, elevated levels of GGT may also be seen in non-alcohol related liver diseases, diabetes, obesity or overweight, heart failure, hyperthyroidism and some medications.[143] Phosphatidylethanol (PEth) is a biomarker that is present in the red blood cells for several weeks after drinking, with its levels grossly corresponding to amount of alcohol consumed, and a detection limit as long as 5 weeks, making it a useful test to assess continued alcohol use.[143] Phosphatidylethanol is considered to have a high specificity, which means that a negative test result is very likely to mean the subject is not alcohol dependent.[144][145] Studies have consistently measured PEth specificity of 100%.[145]

Ethyl glucuronide may be measured to assess recent alcohol intake, with levels being detected in urine up to 48 hours after alcohol intake. However, it is a poor measure of the amount of alcohol consumed.[143] Measurement of ethanol levels in the blood, urine and breath are also used to assess recent alcohol intake, often in the emergency setting.[143]

Other laboratory markers of chronic alcohol misuse include:[146]

* Macrocytosis (enlarged MCV)
* Moderate elevation of AST and ALT and an AST: ALT ratio of 2:1
* High carbohydrate deficient transferrin (CDT)

Electrolyte and acid-base abnormalities including hypokalemia, hypomagnesemia, hyponatremia, hyperuricemia, metabolic acidosis, and respiratory alkalosis are common in people with alcohol use disorders.[10]

Alcohol use monitoring (both by self report or by biomarkers) is very important to the success of treatment of alcohol misuse. However, the cost of biomarkers and the intrusiveness of constant monitoring may limit their utility.[144]

## Prevention

The World Health Organization, the European Union and other regional bodies, national governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism.[147][148]

Increasing the age at which alcohol can be purchased, and banning or restricting alcohol beverage advertising are common methods to reduce alcohol use among adolescents and young adults in particular, see Alcoholism in adolescence. Another common method of alcoholism prevention is taxation of alcohol products – increasing price of alcohol by 10% is linked with reduction of consumption of up to 10%.[149]

Credible, evidence-based educational campaigns in the mass media about the consequences of alcohol misuse have been recommended. Guidelines for parents to prevent alcohol misuse amongst adolescents, and for helping young people with mental health problems have also been suggested.[150]

Because alcohol is often used for self-medication of conditions like anxiety temporarily, prevention of alcoholism may be attempted by reducing the severity or prevalence of stress and anxiety in individuals.[9][18]

## Management

Treatments are varied because there are multiple perspectives of alcoholism. Those who approach alcoholism as a medical condition or disease recommend differing treatments from, for instance, those who approach the condition as one of social choice. Most treatments focus on helping people discontinue their alcohol intake, followed up with life training and/or social support to help them resist a return to alcohol use. Since alcoholism involves multiple factors which encourage a person to continue drinking, they must all be addressed to successfully prevent a relapse. An example of this kind of treatment is detoxification followed by a combination of supportive therapy, attendance at self-help groups, and ongoing development of coping mechanisms. Much of the treatment community for alcoholism supports an abstinence-based zero tolerance approach popularized by the 12 step program of Alcoholics Anonymous; however, some prefer a harm-reduction approach.[151]

### Cessation of alcohol intake

Medical treatment for alcohol detoxification usually involves administration of a benzodiazepine, in order to ameliorate alcohol withdrawal syndrome's adverse impact.[152][153] The addition of phenobarbital improves outcomes if benzodiazepine administration lacks the usual efficacy, and phenobarbital alone might be an effective treatment.[154] Propofol also might enhance treatment for individuals showing limited therapeutic response to a benzodiazepine.[155][156] Individuals who are only at risk of mild to moderate withdrawal symptoms can be treated as outpatients. Individuals at risk of a severe withdrawal syndrome as well as those who have significant or acute comorbid conditions can be treated as inpatients. Direct treatment can be followed by a treatment program for alcohol dependence or alcohol use disorder to attempt to reduce the risk of relapse.[22] Experiences following alcohol withdrawal, such as depressed mood and anxiety, can take weeks or months to abate while other symptoms persist longer due to persisting neuroadaptations.[79]

### Psychological

A regional service center for Alcoholics Anonymous

Various forms of group therapy or psychotherapy are sometimes used to encourage and support abstinence from alcohol, or to reduce alcohol consumption to levels that are not associated with adverse outcomes. Mutual-aid group-counseling is an approach used to facilitate relapse prevention.[25] Alcoholics Anonymous was one of the earliest organizations formed to provide mutual peer support and non-professional counseling, however the effectiveness of Alcoholics Anonymous is disputed.[157] A 2020 Cochrane review concluded that Twelve-Step Facilitation (TSF) probably achieves outcomes such as fewer drinks per drinking day, however evidence for such a conclusion comes from low to moderate certainty evidence "so should be regarded with caution".[158] Others include LifeRing Secular Recovery, SMART Recovery, Women for Sobriety, and Secular Organizations for Sobriety.[159]

Manualized[160] Twelve Step Facilitation (TSF) interventions (i.e. therapy which encourages active, long-term Alcoholics Anonymous participation) for Alcohol Use Disorder lead to higher abstinence rates, compared to other clinical interventions and to wait-list control groups.[161]

### Moderate drinking

Moderate drinking amongst people with alcohol dependence—often termed controlled drinking—has been subject to significant controversy.[162] Indeed, much of the skepticism toward the viability of moderate drinking goals stems from historical ideas about alcoholism, now replaced with alcohol use disorder or alcohol dependence in most scientific contexts. A 2021 meta-analysis and systematic review of interventions designed to promote moderate (controlled) drinking found that this treatment model demonstrated a non-inferior outcome compared to an abstinence-oriented approach for many people with alcohol problems.[163][lower-alpha 2]

Mutual support programs such as Moderation Management and DrinkWise do not mandate complete abstinence. While most people with severe alcohol use disorders are unable to limit their drinking, individuals with mild to moderate alcohol problems are often able to limit the quantity and frequency of alcohol consumption such that their drinking does not cause harm to themselves or others. A 2002 US study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed that 17.7% of individuals diagnosed as alcohol dependent more than one year prior returned to low-risk drinking. This group, however, showed fewer initial symptoms of dependency.[164]

A follow-up study, using the same subjects that were judged to be in remission in 2001–2002, examined the rates of return to problem drinking in 2004–2005. The study found abstinence from alcohol was the most stable form of remission for recovering alcoholics.[165] There was also a 1973 study showing chronic alcoholics drinking moderately again,[166] but a 1982 follow-up showed that 95% of subjects were not able to maintain drinking in moderation over the long term.[167][168] Another study was a long-term (60 year) follow-up of two groups of alcoholic men which concluded that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence."[169] Internet based measures appear to be useful at least in the short term.[170]

### Medications

In the United States there are four approved medications for alcoholism: acamprosate, two methods of using naltrexone and disulfiram.[171]

* Acamprosate may stabilise the brain chemistry that is altered due to alcohol dependence via antagonising the actions of glutamate, a neurotransmitter which is hyperactive in the post-withdrawal phase.[172] By reducing excessive NMDA activity which occurs at the onset of alcohol withdrawal, acamprosate can reduce or prevent alcohol withdrawal related neurotoxicity.[173] Acamprosate reduces the risk of relapse amongst alcohol-dependent persons.[174][175] Acamprosate is not recommended in those with advanced, decompensated liver cirrhosis due to the risk of liver toxicity.[143] It may be taken by those with milder liver disease. And it also cannot be taken by those with severe kidney disease.[132]
* Naltrexone is a competitive antagonist for opioid receptors, effectively blocking the effects of endorphins and opioids. Naltrexone may be given as a daily oral tablet or as a monthly intramuscular injection.[143] Naltrexone is used to decrease cravings for alcohol and encourage abstinence. Alcohol causes the body to release endorphins, which in turn release dopamine and activate the reward pathways; hence in the body Naltrexone reduces the pleasurable effects from consuming alcohol.[176] Evidence supports a reduced risk of relapse among alcohol-dependent persons and a decrease in excessive drinking.[175] Naltrexone should not be used in those with advanced liver disease or those with acute hepatitis due to the risk of liver toxicity.[143] Naltrexone should also not be used in those who take opiates as it can precipitate an opiate withdrawal.[132] The once monthly intramuscular injectable naltrexone was found to be slightly more effective in some studies, leading to 5 less drinking days per month compared to the oral form.[132] Nalmefene also appears effective and works in a similar manner.[175]
* Disulfiram prevents the elimination of acetaldehyde by inhibiting the enzyme acetaldehyde dehydrogenase. Acetaldehyde is a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many hangover symptoms from alcohol use. The overall effect is acute discomfort when alcohol is ingested characterized by flushing, nausea, a rapid heart rate and low blood pressure.[143] Disulfiram should not be used in those with advanced liver disease due to the risk of life-threatening liver toxicity.[143] The evidence of effectiveness of disulfiram in the treatment of alcohol misuse is limited.[132]

Several other drugs are also used and many are under investigation.[177]

* Benzodiazepines are a first line medication in the management of acute alcohol withdrawal, however their use outside of the acute withdrawal period is not recommended.[143] Benzodiazepines with a shorter half life, such as lorazepam or oxazepam are preferred in the treatment of alcohol withdrawal as their shorter half lives and less active metabolites have a lower risk of confusion in those with liver disease.[143] If used long-term, they can cause a worse outcome in alcoholism. Alcoholics on chronic benzodiazepines have a lower rate of achieving abstinence from alcohol than those not taking benzodiazepines. Initiating prescriptions of benzodiazepines or sedative-hypnotics in individuals in recovery has a high rate of relapse with one author reporting more than a quarter of people relapsed after being prescribed sedative-hypnotics. Those who are long-term users of benzodiazepines should not be withdrawn rapidly, as severe anxiety and panic may develop, which are known risk factors for alcohol use disorder relapse. Taper regimes of 6–12 months have been found to be the most successful, with reduced intensity of withdrawal.[178][179]
* Calcium carbimide works in the same way as disulfiram; it has an advantage in that the occasional adverse effects of disulfiram, hepatotoxicity and drowsiness, do not occur with calcium carbimide.[180]
* Ondansetron and topiramate are supported by tentative evidence in people with certain genetic patterns.[181][182] Evidence for ondansetron is stronger in people who have recently started to abuse alcohol.[181] Topiramate is a derivative of the naturally occurring sugar monosaccharide D-fructose. Review articles characterize topiramate as showing "encouraging",[181] "promising",[181] "efficacious",[183] and "insufficient"[184] results in the treatment of alcohol use disorders.[181][183][184]

Evidence does not support the use of selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), antipsychotics, or gabapentin.[175]

## Research

Topiramate, a derivative of the naturally occurring sugar monosaccharide D-fructose, has been found effective in helping alcoholics quit or cut back on the amount they drink. Evidence suggests that topiramate antagonizes excitatory glutamate receptors, inhibits dopamine release, and enhances inhibitory gamma-aminobutyric acid function. A 2008 review of the effectiveness of topiramate concluded that the results of published trials are promising, however as of 2008, data was insufficient to support using topiramate in conjunction with brief weekly compliance counseling as a first-line agent for alcohol dependence.[185] A 2010 review found that topiramate may be superior to existing alcohol pharmacotherapeutic options. Topiramate effectively reduces craving and alcohol withdrawal severity as well as improving quality-of-life-ratings.[186]

Baclofen, a GABAB receptor agonist, is under study for the treatment of alcoholism.[187] According to a 2017 Cochrane Systematic Review, there is insufficient evidence to determine the effectiveness or safety for the use of baclofen for withdrawal symptoms in alcoholism.[188] Psilocybin-assisted psychotherapy is under study for the treatment of patients with alcohol use disorder.[189][190]

### Dual addictions and dependencies

Alcoholics may also require treatment for other psychotropic drug addictions and drug dependencies. The most common dual dependence syndrome with alcohol dependence is benzodiazepine dependence, with studies showing 10–20% of alcohol-dependent individuals had problems of dependence and/or misuse problems of benzodiazepine drugs such as diazepam or clonazepam. These drugs are, like alcohol, depressants. Benzodiazepines may be used legally, if they are prescribed by doctors for anxiety problems or other mood disorders, or they may be purchased as illegal drugs. Benzodiazepine use increases cravings for alcohol and the volume of alcohol consumed by problem drinkers.[191]

Benzodiazepine dependency requires careful reduction in dosage to avoid benzodiazepine withdrawal syndrome and other health consequences. Dependence on other sedative-hypnotics such as zolpidem and zopiclone as well as opiates and illegal drugs is common in alcoholics. Alcohol itself is a sedative-hypnotic and is cross-tolerant with other sedative-hypnotics such as barbiturates, benzodiazepines and nonbenzodiazepines. Dependence upon and withdrawal from sedative-hypnotics can be medically severe and, as with alcohol withdrawal, there is a risk of psychosis or seizures if not properly managed.[192]

## Epidemiology

Disability-adjusted life year for alcohol use disorders per million inhabitants in 2012

234–806

814–1,501

1,551–2,585

2,838

2,898–3,935

3,953–5,069

5,168

5,173–5,802

5,861–8,838

9,122–25,165

Alcohol consumption per person 2016[193]

The World Health Organization estimates that as of 2016[update] there are about 380 million people with alcoholism worldwide (5.1% of the population over 15 years of age),[2][3] with it being most common among males and young adults.[9] Geographically, it is least common in Africa (1.1% of the population) and has the highest rates in Eastern Europe (11%).[9]

As of 2015[update] in the United States, about 17 million (7%) of adults and 0.7 million (2.8%) of those age 12 to 17 years of age are affected.[16] About 12% of American adults have had an alcohol dependence problem at some time in their life.[194]

In the United States and Western Europe, 10–20% of men and 5–10% of women at some point in their lives will meet criteria for alcoholism.[195] In England, the number of "dependent drinkers" was calculated as over 600,000 in 2019.[196] Estonia had the highest death rate from alcohol in Europe in 2015 at 8.8 per 100,000 population.[197] In the United States, 30% of people admitted to hospital have a problem related to alcohol.[198]

Within the medical and scientific communities, there is a broad consensus regarding alcoholism as a disease state. For example, the American Medical Association considers alcohol a drug and states that "drug addiction is a chronic, relapsing brain disease characterized by compulsive drug seeking and use despite often devastating consequences. It results from a complex interplay of biological vulnerability, environmental exposure, and developmental factors (e.g., stage of brain maturity)."[199] Alcoholism has a higher prevalence among men, though, in recent decades, the proportion of female alcoholics has increased.[48] Current evidence indicates that in both men and women, alcoholism is 50–60% genetically determined, leaving 40–50% for environmental influences.[200] Most alcoholics develop alcoholism during adolescence or young adulthood.[83]

## Prognosis

Alcohol use disorders deaths per million persons in 2012

1–3

4–6

7–13

14–20

21–37

38–52

53–255

Alcoholism often reduces a person's life expectancy by around ten years.[12] The most common cause of death in alcoholics is from cardiovascular complications.[201] There is a high rate of suicide in chronic alcoholics, which increases the longer a person drinks. Approximately 3–15% of alcoholics die by suicide,[202] and research has found that over 50% of all suicides are associated with alcohol or drug dependence. This is believed to be due to alcohol causing physiological distortion of brain chemistry, as well as social isolation. Suicide is also common in adolescent alcohol abusers. Research in 2000 found that 25% of suicides in adolescents were related to alcohol abuse.[203]

Among those with alcohol dependence after one year, some met the criteria for low-risk drinking, even though only 26% of the group received any treatment, with the breakdown as follows: 25% were found to be still dependent, 27% were in partial remission (some symptoms persist), 12% asymptomatic drinkers (consumption increases chances of relapse) and 36% were fully recovered comprising 18% low-risk drinkers plus 18% abstainers.[204] In contrast, however, the results of a long-term (60-year) follow-up of two groups of alcoholic men indicated that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence ... return-to-controlled drinking, as reported in short-term studies, is often a mirage."[169]

## History

Adriaen Brouwer, Inn with Drunken Peasants, 1620s 1904 advertisement describing alcoholism as a disease

Alcohol has a long history of use and misuse throughout recorded history. Biblical, Egyptian and Babylonian sources record the history of abuse and dependence on alcohol. In some ancient cultures alcohol was worshiped and in others, its misuse was condemned. Excessive alcohol misuse and drunkenness were recognized as causing social problems even thousands of years ago.

In 1647 a Greek monk named Agapios was the first to document that chronic alcohol misuse was associated with toxicity to the nervous system and body which resulted in a range of medical disorders such as seizures, paralysis and internal bleeding. However, the defining of habitual drunkenness as it was then known as and its adverse consequences were not well established medically until the 18th century.

In 1784, Benjamin Rush emphasises substance as a causal agent.[205] From the mid-19th century onwards, the bivariate model gradually gained acceptance, taking into account both the substance and the person.[205] From the 1970s onwards, the triangle model became the norm, incorporating the substance, the person and the social context.[205]

The term dipsomania was coined by German physician C. W. Hufeland in 1819 before it was superseded by alcoholism.[206][207] That term now has a more specific meaning.[208] The term alcoholism was first used by Swedish physician Magnus Huss in an 1852 publication to describe the systemic adverse effects of alcohol.[4]

In the 1910s and 1920s, the effects of alcohol misuse and chronic drunkenness boosted membership of the temperance movement and led to the prohibition of alcohol in many countries in North America and the Nordic countries, nationwide bans on the production, importation, transportation, and sale of alcoholic beverages that generally remained in place until the late 1920s or early 1930s; these policies resulted in the decline of death rates from cirrhosis and alcoholism.[209] In 2005, alcohol dependence and misuse was estimated to cost the US economy approximately 220 billion dollars per year, more than cancer and obesity.[210]

## Evolution

### Overview

Alcoholism is a very complex and difficult problem to understand and solve in society. The evolutionary perspective is often overlooked but is a key perspective in understanding this disease. The evolution of alcoholism is thought to originate at the consumption of fermented fruits.[211] Those that are able to find and successfully consume ripe fruit had an advantage because of the additional source of nutrients.[211] This led to an association of ethanol (found in fermenting fruits) with energy. Ethanol is produced inside of ripening fruits which contain significant amounts of nutrients and high caloric value. Natural selection favoring primates attracted to alcohol, even if the benefits were not direct, is one hypothesis for why some people are more susceptible to alcoholism than others.[212] This is an example of Darwinian medicine, and is part of the explanation for why some people may be more susceptible, the whole story about who is more susceptible to alcoholism also includes, genetics, environment, family background, and other stressors, all of which are important and tend to be studied more than the evolutionary aspect. Alcoholism is a disease of nutritional excess, similar to obesity.[212] Early human consumption of ethanol was a byproduct as well as a source of nutrients, but in an industrial society where there is an excess amount of alcohol, this consumption can become a problem.[213]

### Fermented fruit consumption

Early humans regularly ingested ethanol which was made from yeast-based fermentation of naturally occurring fruit sugars.[214] The sugars found in fruit are an incentive for dispersers to consume and then eventually disperse seeds; the fruit pulp also serves as the base for ethanol production.[214] The development of ethanol in fruits occurs during the ripening process which leaves fruits more available for consumption by dispersers. Unripe fruits contain seeds that have not matured, and if those seeds were to be eaten and dispersed it would be maladaptive. Unripe fruits are also less available to microbes[211] to consume. The ripening of fruit can be seen as a race between dispersers and microbes. Ethanol inhibits the growth of microbes but it also typically makes fruit inedible to vertebrates as well. So, when an organism is able to consume alcohol, those fruits are available to them and not others. There is also an additional advantage to ethanol consumption which is the high caloric value of ethanol. The caloric value of ethanol is 7.1 kcal/g which is nearly twice that of carbohydrates which is 4.1 kcal/g.[211]

### Ancestral ethanol consumption

Humans originate from a primarily frugivorous (fruit eater) lineage of primates. A large part of primate evolution occurred in warm equatorial climates where fruit fermentation occurred quickly and regularly. The ancestors of human and nonhuman primates were routinely exposed to low levels of ethanol through their fruit eating.[214] This led to corresponding adaptation and preference for ethanol that has been preserved in modern humans.[213]

### Hormetic effect

The Hormetic effect or Hormesis is another aspect of the ancestral relationship humans have with alcohol. The Homertic effect is the idea that low concentrations to stressors, in this case ethanol, can be beneficial, but higher concentrations are stressful and cause harm. The evolutionary explanation for hormesis is based on the assumption that natural selection maximises relative fitness.[214] This is an explanation for why organisms developed the metabolic machinery to consume ethanol in order to maximise its benefits. The Homertic effect in relation to alcohol consumption has not been studied thoroughly in humans but has in the fruit fly genus, Drosophila. The longevity of Drosophila is enhanced at very low concentrations of ethanol but is decreased at higher concentrations. Additionally, the ability to produce an abundant amount of offspring increases in the low concentration presence of ethanol. Other organisms whose diet consists of fermenting fruit share these same characteristics and this may also include humans, seeing as they do have the ability and metabolic equipment to have hormetic advantages from ethanol at low concentrations.[214]

### Humans frugivory

Humans have a far reaching frugivorous dietary heritage. Frugivorous adaptations among primates is thought to have started at least 40 million years ago, though likely earlier. Humans' closest relatives, the chimpanzees, have a predominantly frugivorous diet which supports the idea of their common ancestor's frugivorous dietary heritage. Additionally, gibbons and orangutans are almost exclusively frugivory, while gorillas which are partially frugivory.[214] Because of this shared evolutionary history, nonhuman primates have been used as models to understand alcoholism. Researchers have used macaques to test whether natural selection supports genes for traits that lead to excessive alcohol consumption because these same traits may enhance fitness in other contexts. Because of close lineages, this may be true as well for humans.[215]

### Modern alcoholism

In prehistoric human ancestry, there were advantages to human consumption of ethanol in fermenting fruits. But as the world changed and living conditions turned to resemble current modern industrial society, human access to ethanol changed as well. Similar to sugars and fats, ethanol was only found in very low concentrations and because of its tie to fruit sugars, human consumption of it was necessary. So, just like people crave sugar and fat because prehistorically they are only minimally obtainable and necessary for bodily functions, ethanol can also be craved and be over consumed. In society sugar, fats and ethanol are readily available and in combination with our craving for it, both obesity and alcoholism can be considered diseases of nutritional excess.[212]

## Society and culture

The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to society; for example, money due to lost labor-hours, medical costs due to injuries due to drunkenness and organ damage from long-term use, and secondary treatment costs, such as the costs of rehabilitation facilities and detoxification centers. Alcohol use is a major contributing factor for head injuries, motor vehicle injuries (27%), interpersonal violence (18%), suicides (18%), and epilepsy (13%).[216] Beyond the financial costs that alcohol consumption imposes, there are also significant social costs to both the alcoholic and their family and friends.[68] For instance, alcohol consumption by a pregnant woman can lead to an incurable and damaging condition known as fetal alcohol syndrome, which often results in cognitive deficits, mental health problems, an inability to live independently and an increased risk of criminal behaviour, all of which can cause emotional stress for parents and caregivers.[217][218]

Estimates of the economic costs of alcohol misuse, collected by the World Health Organization, vary from 1–6% of a country's GDP.[219] One Australian estimate pegged alcohol's social costs at 24% of all drug misuse costs; a similar Canadian study concluded alcohol's share was 41%.[220] One study quantified the cost to the UK of all forms of alcohol misuse in 2001 as £18.5–20 billion.[196][221] All economic costs in the United States in 2006 have been estimated at $223.5 billion.[222]

The idea of hitting rock bottom refers to an experience of stress that can be attributed to alcohol misuse.[223] There is no single definition for this idea, and people may identify their own lowest points in terms of lost jobs, lost relationships, health problems, legal problems, or other consequences of alcohol misuse.[224] The concept is promoted by 12-step recovery groups and researchers using the transtheoretical model of motivation for behavior change.[224] The first use of this slang phrase in the formal medical literature appeared in a 1965 review in the British Medical Journal,[224] which said that some men refused treatment until they "hit rock bottom", but that treatment was generally more successful for "the alcohol addict who has friends and family to support him" than for impoverished and homeless addicts.[225]

Stereotypes of alcoholics are often found in fiction and popular culture. The "town drunk" is a stock character in Western popular culture. Stereotypes of drunkenness may be based on racism or xenophobia, as in the fictional depiction of the Irish as heavy drinkers.[226] Studies by social psychologists Stivers and Greeley attempt to document the perceived prevalence of high alcohol consumption amongst the Irish in America.[227] Alcohol consumption is relatively similar between many European cultures, the United States, and Australia. In Asian countries that have a high gross domestic product, there is heightened drinking compared to other Asian countries, but it is nowhere near as high as it is in other countries like the United States. It is also inversely seen, with countries that have very low gross domestic product showing high alcohol consumption.[228] In a study done on Korean immigrants in Canada, they reported alcohol was typically an integral part of their meal but is the only time solo drinking should occur. They also generally believe alcohol is necessary at any social event, as it helps conversations start.[229]

Peyote, a psychoactive agent, has even shown promise in treating alcoholism. Alcohol had actually replaced peyote as Native Americans' psychoactive agent of choice in rituals when peyote was outlawed.[230]

## See also

* Addictive personality
* Alcohol-related traffic crashes in the United States
* Alcoholism in family systems
* Collaborative Study on the Genetics of Alcoholism
* CRAFFT Screening Test
* Disulfiram-like drug
* High-functioning alcoholic
* Holiday heart syndrome
* List of countries by alcohol consumption

## Notes

1. ↑ "Twelve-Step Facilitation (TSF) interventions include extended counseling, adopting some of the techniques and principles of AA, as well as brief interventions designed to link individuals to community AA groups."[27]
2. ↑ non-inferiority has a specialized meaning in research design and statistical analysis; for more information see https://healthjournalism.org/glossary-terms/non-inferiority/; see also Schumi J, Wittes JT. Through the looking glass: understanding non-inferiority. Trials. 2011;12:106. Published 2011 May 3. doi:10.1186/1745-6215-12-106.

## References

1. ↑ Understanding and Treating Alcoholism Volume I: An Empirically Based Clinician's Handbook for the Treatment of Alcoholism: Volume II: Biological, Psychological, and Social Aspects of Alcohol Consumption and Abuse. Hoboken: Taylor and Francis. 2014. p. 55. ISBN 978-1-317-78314-5. https://books.google.com/books?id=2k57AgAAQBAJ&pg=PA55. "The World Health Organization defines alcoholism as any drinking which results in problems"
2. ↑ 2.0 2.1 Global status report on alcohol and health 2018. World Health Organization. 2018. pp. 72, 80. ISBN 978-92-4-156563-9. https://apps.who.int/iris/bitstream/handle/10665/274603/9789241565639-eng.pdf?ua=1. Retrieved 1 July 2024.
3. ↑ 3.0 3.1 "World Population Prospects – Population Division". United Nations. https://population.un.org/wpp/DataQuery/.
4. ↑ 4.0 4.1 Alcoholismus chronicus, eller Chronisk alkoholssjukdom. Stockholm und Leipzig. 1852. https://books.google.com/books?id=wt6r2Zw8sCEC&pg=PA5. Retrieved 19 February 2008.
5. ↑ 5.0 5.1 Morris, J.; Moss, A. C.; Albery, I. P.; Heather, N. (1 January 2022). "The 'alcoholic other': Harmful drinkers resist problem recognition to manage identity threat". Addictive Behaviors 124. doi:10.1016/j.addbeh.2021.107093. PMID 34500234. https://www.sciencedirect.com/science/article/abs/pii/S0306460321002781. Retrieved 1 July 2024.
6. ↑ 6.0 6.1 Ashford, Robert D.; Brown, Austin M.; Curtis, Brenda (1 August 2018). "Substance use, recovery, and linguistics: The impact of word choice on explicit and implicit bias". Drug and Alcohol Dependence 189: 131–138. doi:10.1016/j.drugalcdep.2018.05.005. PMID 29913324.
7. ↑ Rehm, J (2011). "The risks associated with alcohol use and alcoholism". Alcohol Research & Health 34 (2): 135–143. PMID 22330211.
8. ↑ Chambers English Thesaurus. Allied Publishers. p. 175. ISBN 978-81-86062-04-3. https://books.google.com/books?id=IamKT5uk5lMC&pg=PA175.
9. ↑ 9.00 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09 9.10 9.11 Diagnostic and statistical manual of mental disorders: DSM-5 (5 ed.). Washington, DC: American Psychiatric Association. 2013. pp. 490–97. ISBN 978-0-89042-554-1. https://archive.org/details/diagnosticstatis0005unse/page/490.
10. ↑ 10.0 10.1 10.2 "Alcohol's Effects on the Body". 14 September 2011. http://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body.
11. ↑ "Moderate alcohol consumption and the immune system: a review". The British Journal of Nutrition 98 (Suppl 1): S111-5. October 2007. doi:10.1017/S0007114507838049. PMID 17922947.
12. ↑ 12.0 12.1 12.2 "Recognition and management of withdrawal delirium (delirium tremens)". The New England Journal of Medicine 371 (22): 2109–13. November 2014. doi:10.1056/NEJMra1407298. PMID 25427113. http://www.escholarship.org/uc/item/08b9z9th. Retrieved 1 July 2024.
13. ↑ "Fetal Alcohol Exposure". 14 September 2011. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-fetal-alcohol-spectrum-disorders.
14. ↑ Ritzer, George, ed (2007-02-15). The Blackwell Encyclopedia of Sociology (1 ed.). Wiley. doi:10.1002/9781405165518.wbeosa039.pub2. ISBN 978-1-4051-2433-1. https://onlinelibrary.wiley.com/doi/book/10.1002/9781405165518. Retrieved 1 July 2024.
15. ↑ ((GBD 2013 Mortality Causes of Death Collaborators)) (January 2015). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet 385 (9963): 117–71. doi:10.1016/S0140-6736(14)61682-2. PMID 25530442.
16. ↑ 16.0 16.1 16.2 "Alcohol Facts and Statistics". National Institute on Alcohol Abuse and Alcoholism (NIAAA). 14 September 2011. http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics.
17. ↑ "[Genetic predisposition for alcoholism]". Therapeutische Umschau 57 (4): 179–84. April 2000. doi:10.1024/0040-5930.57.4.179. PMID 10804873.
18. ↑ 18.0 18.1 "Stress, epigenetics, and alcoholism". Alcohol Research 34 (4): 495–505. 2012. doi:10.35946/arcr.v34.4.13. PMID 23584115.
19. ↑ "Recognition of alcohol and substance abuse". American Family Physician 67 (7): 1529–32. April 2003. PMID 12722853.
20. ↑ "Health and Ethics Policies of the AMA House of Delegates". June 2008. p. 33. http://www.ama-assn.org/ad-com/polfind/Hlth-Ethics.pdf. "H-30.997 Dual Disease Classification of Alcoholism: The AMA reaffirms its policy endorsing the dual classification of alcoholism under both the psychiatric and medical sections of the International Classification of Diseases. (Res. 22, I-79; Reaffirmed: CLRPD Rep. B, I-89; Reaffirmed: CLRPD Rep. B, I-90; Reaffirmed by CSA Rep. 14, A-97; Reaffirmed: CSAPH Rep. 3, A-07)"
21. ↑ "A review of the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, and USAUDIT for screening in the United States: Past issues and future directions". The American Journal of Drug and Alcohol Abuse 44 (6): 578–586. 2018. doi:10.1080/00952990.2018.1456545. PMID 29723083.
22. ↑ 22.0 22.1 22.2 22.3 "Ambulatory detoxification of patients with alcohol dependence". American Family Physician 71 (3): 495–502. February 2005. PMID 15712624.
23. ↑ "Treatment of alcohol dependence: recent progress and reduction of consumption". Minerva Medica 105 (6): 447–66. December 2014. PMID 25392958.
24. ↑ "Treatment of the depressed alcoholic patient". Current Psychiatry Reports 14 (6): 610–8. December 2012. doi:10.1007/s11920-012-0314-7. PMID 22907336.
25. ↑ 25.0 25.1 "Analytic complexities associated with group therapy in substance abuse treatment research: problems, recommendations, and future directions". Experimental and Clinical Psychopharmacology 14 (2): 265–73. May 2006. doi:10.1037/1064-1297.14.2.265. PMID 16756430.
26. ↑ "Management of alcohol abuse". Clinics in Liver Disease 16 (4): 737–62. November 2012. doi:10.1016/j.cld.2012.08.006. PMID 23101980.
27. ↑ Kelly, John F.; Humphreys, Keith; Ferri, Marica (2020). "Alcoholics Anonymous and other 12-step programs for alcohol use disorder". Cochrane Database of Systematic Reviews 3 (CD012880): 15. doi:10.1002/14651858.CD012880.pub2. PMID 32159228.
28. ↑ Kelly, John F.; Humphreys, Keith; Ferri, Marica (2020). "Alcoholics Anonymous and other 12-step programs for alcohol use disorder". Cochrane Database of Systematic Reviews 3 (3). doi:10.1002/14651858.CD012880.pub2. PMID 32159228.
29. ↑ Kelly, John F.; Abry, Alexandra; Ferri, Marica; Humphreys, Keith (2020). "Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers". Alcohol and Alcoholism 55 (6): 641–651. doi:10.1093/alcalc/agaa050. PMID 32628263.
30. ↑ "Alcoholics Anonymous most effective path to alcohol abstinence". 2020. https://med.stanford.edu/news/all-news/2020/03/alcoholics-anonymous-most-effective-path-to-alcohol-abstinence.html.
31. ↑ "Binge Drinking". 28 February 2024. https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm#:~:text=Binge drinking is the most,on an occasion for women.
32. ↑ 32.0 32.1 "Alcohol dependence: a commentary on mechanisms". Alcohol and Alcoholism 31 (4): 333–40. July 1996. doi:10.1093/oxfordjournals.alcalc.a008159. PMID 8879279.
33. ↑ "Psychiatric aspects of alcohol misuse". Hospital Medicine 60 (3): 169–72. March 1999. doi:10.12968/hosp.1999.60.3.1060. PMID 10476237.
34. ↑ Drug abuse prevention: a school and community partnership. Sudbury, MA: Jones and Bartlett. 2003. pp. 40–45. ISBN 978-0-7637-1461-1. https://books.google.com/books?id=Cm1MfcBSucUC.
35. ↑ "Biology". The Volume Library. 1. Nashville, TN: The Southwestern Company. 2009. p. 29. ISBN 978-0-87197-208-8. https://books.google.com/books?id=RE9OwGtvDMACf.
36. ↑ 36.0 36.1 Dasgupta, Amitava (2017). "Alcohol a double-edged sword". Alcohol, Drugs, Genes and the Clinical Laboratory. Elsevier. p. 1–21. doi:10.1016/b978-0-12-805455-0.00001-4. ISBN 978-0-12-805455-0. https://linkinghub.elsevier.com/retrieve/pii/B9780128054550000014. Retrieved 2025-07-29.
37. ↑ 37.0 37.1 Holmwood, Chris; Cock, Victoria (2023). "Physical Problems Associated with Alcohol". Alcohol Use: Assessment, Withdrawal Management, Treatment and Therapy. Cham: Springer International Publishing. pp. 99–112. doi:10.1007/978-3-031-18381-2_6. ISBN 978-3-031-18380-5. https://link.springer.com/10.1007/978-3-031-18381-2_6. Retrieved 2025-07-29.
38. ↑ Dasgupta, Amitava (2019). "Alcohol". Critical Issues in Alcohol and Drugs of Abuse Testing. Elsevier. p. 1–16. doi:10.1016/b978-0-12-815607-0.00001-0. ISBN 978-0-12-815607-0. https://linkinghub.elsevier.com/retrieve/pii/B9780128156070000010. Retrieved 2025-07-29.
39. ↑ Greenfield, Thomas K.; Cook, Won K.; Karriker-Jaffe, Katherine J.; Li, Libo; Room, Robin (2021). "Are Countries' Drink-Driving Policies Associated With Harms Involving Another Driver's Impairment?". Alcoholism: Clinical and Experimental Research 45 (2): 429–435. doi:10.1111/acer.14526. ISSN 0145-6008. PMID 33277939.
40. ↑ "No level of alcohol consumption is safe for our health" (in en). World Health Organization. https://www.who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health.
41. ↑ 41.0 41.1 "Alcohol and cardiovascular health: the dose makes the poison…or the remedy". Mayo Clinic Proceedings 89 (3): 382–93. March 2014. doi:10.1016/j.mayocp.2013.11.005. PMID 24582196.
42. ↑ American Medical Association (2003). "Duodenal Ulcer". Complete Medical Encyclopedia (First ed.). New York: Random House Reference. p. 485. ISBN 978-0-8129-9100-0. https://books.google.com/books?id=WGURAQAAMAAJ. Retrieved 1 July 2024.
43. ↑ Gormley, Mark; Creaney, Grant; Schache, Andrew; Ingarfield, Kate; Conway, David I. (2022-11-11). "Reviewing the epidemiology of head and neck cancer: definitions, trends and risk factors". British Dental Journal 233 (9): 780–786. doi:10.1038/s41415-022-5166-x. ISSN 0007-0610. PMID 36369568.
44. ↑ "[Neurophysiologic findings in chronic alcohol abuse]" (in de). Psychiatrie, Neurologie, und Medizinische Psychologie 37 (3): 129–32. March 1985. PMID 2988001.
45. ↑ "Alcoholic diseases in hepato-gastroenterology: a point of view". Hepato-Gastroenterology 55 (82–83): 371–7. 2008. PMID 18613369.
46. ↑ 10th Special Report to the U.S. Congress on Alcohol and Health , 2000, U.S. Department of Health and Human Services, Public Health Service National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism.
47. ↑ 47.0 47.1 47.2 "Alcoholism and alcohol abuse among women: report of the Council on Scientific Affairs. American Medical Association". Journal of Women's Health 7 (7): 861–71. September 1998. doi:10.1089/jwh.1998.7.861. PMID 9785312.
48. ↑ 48.0 48.1 "Gender-specific differences in alcoholism: implications for treatment". Archives of Women's Mental Health 6 (4): 253–8. November 2003. doi:10.1007/s00737-003-0014-8. PMID 14628177.
49. ↑ "[Alcoholic ketoacidosis]". Revista Medico-Chirurgicala a Societatii de Medici Si Naturalisti Din Iasi 112 (2): 321–6. April–June 2008. PMID 19294998.
50. ↑ "[Alcoholic ketoacidosis: not rare cause of metabolic acidosis]". Revue Médicale Suisse 1 (32): 2106, 2108–10, 2112–5. September 2005. doi:10.53738/REVMED.2005.1.32.2106. PMID 16238232.
51. ↑ "Alcohol metabolism". Clinics in Liver Disease 16 (4): 667–85. November 2012. doi:10.1016/j.cld.2012.08.002. PMID 23101976.
52. ↑ 52.0 52.1 "Alcoholism-associated molecular adaptations in brain neurocognitive circuits". 8 July 2008. http://www.eurekalert.org/pub_releases/2008-07/econ-ma070808.php.
53. ↑ "Alcoholism and the brain: an overview". Alcohol Research & Health 27 (2): 125–33. 2003. PMID 15303622.
54. ↑ "Social cognition in alcoholism: a link to prefrontal cortex dysfunction?". Addiction 103 (5): 726–35. May 2008. doi:10.1111/j.1360-0443.2008.02157.x. PMID 18412750.
55. ↑ "Psychopathology of alcoholics during withdrawal and early abstinence". European Psychiatry 15 (8): 483–8. December 2000. doi:10.1016/S0924-9338(00)00519-8. PMID 11175926.
56. ↑ "Alcoholism and other psychiatric disorders". Hospital & Community Psychiatry 34 (11): 1022–7. November 1983. doi:10.1176/ps.34.11.1022. PMID 6642446.
57. ↑ "Alcohol abuse, substance abuse, and panic disorder". The American Journal of Medicine 92 (1A): 41S–48S. January 1992. doi:10.1016/0002-9343(92)90136-Y. PMID 1346485.
58. ↑ "Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship". The Journal of Clinical Psychiatry 68 (6): 874–80. June 2007. doi:10.4088/JCP.v68n0608. PMID 17592911.
59. ↑ "Comorbidity between DSM-IV alcohol use disorders and major depression: results of a national survey". Drug and Alcohol Dependence 39 (3): 197–206. October 1995. doi:10.1016/0376-8716(95)01160-4. PMID 8556968. https://zenodo.org/record/1258497. Retrieved 1 July 2024.
60. ↑ "Comorbidity between patterns of substance use dependence and psychiatric syndromes". Drug and Alcohol Dependence 64 (2): 233–41. October 2001. doi:10.1016/S0376-8716(01)00126-0. PMID 11543993.
61. ↑ "Alcohol and psychiatric comorbidity". Recent Developments in Alcoholism. Recent Dev Alcohol. 16. Kluwer Academic/Plenum Publishers. 2003. pp. 361–74. doi:10.1007/0-306-47939-7_24. ISBN 978-0-306-47258-9. https://archive.org/details/recentdevelopment00gala/page/361.
62. ↑ "Comparison of induced and independent major depressive disorders in 2,945 alcoholics". The American Journal of Psychiatry 154 (7): 948–57. July 1997. doi:10.1176/ajp.154.7.948. PMID 9210745.
63. ↑ "The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls". Addiction 92 (10): 1289–304. October 1997. doi:10.1111/j.1360-0443.1997.tb02848.x. PMID 9489046.
64. ↑ "A comparison of factors associated with substance-induced versus independent depressions". Journal of Studies on Alcohol and Drugs 68 (6): 805–12. November 2007. doi:10.15288/jsad.2007.68.805. PMID 17960298.
65. ↑ "Alcoholic patients with secondary depression". The American Journal of Psychiatry 140 (6): 711–4. June 1983. doi:10.1176/ajp.140.6.711. PMID 6846629.
66. ↑ 66.0 66.1 66.2 "Women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners". Journal of Social Work 2 (3): 337–56. 2002. doi:10.1177/146801730200200305.
67. ↑ Nolen-Hoeksema, Susan (2004). "Gender differences in risk factors and consequences for alcohol use and problems". Clinical Psychology Review 24 (8): 981–1010. doi:10.1016/j.cpr.2004.08.003. PMID 15533281. https://linkinghub.elsevier.com/retrieve/pii/S0272735804001047. Retrieved 2025-07-25.
68. ↑ 68.0 68.1 68.2 McCully, Chris (2004). Goodbye Mr. Wonderful. Alcohol, Addition and Early Recovery. London: Jessica Kingsley Publishers. ISBN 978-1-84310-265-6. http://www.jkp.com/catalogue/book/9781843102656/contents.
69. ↑ Isralowitz, Richard (2004). Drug use: a reference handbook. Santa Barbara, CA: ABC-CLIO. pp. 122–23. ISBN 978-1-57607-708-5. https://books.google.com/books?id=X0mxxfbIbp4C. Retrieved 1 July 2024.
70. ↑ Langdana, Farrokh K. (2009). Macroeconomic Policy: Demystifying Monetary and Fiscal Policy (2nd ed.). Springer. p. 81. ISBN 978-0-387-77665-1. https://books.google.com/books?id=GCYWQn79JYwC. Retrieved 1 July 2024.
71. ↑ Gifford, Maria (2009). Alcoholism (Biographies of Disease). Greenwood Press. pp. 89–91. ISBN 978-0-313-35908-8. https://books.google.com/books?id=2OJV12astRUC&pg=PA89.
72. ↑ Schadé, Johannes Petrus (2006). The Complete Encyclopedia of Medicine and Health. Foreign Media Books. pp. 132–33. ISBN 978-1-60136-001-4. https://books.google.com/books?id=j8DuEHxSCU4C&pg=PA132.
73. ↑ Gold, Mark. "Children of Alcoholics". Psych Central.com. Psych Central. http://psychcentral.com/lib/2006/children-of-alcoholics/.
74. ↑ Galanter, Marc; Kleber, Herbert D. (2008). The American Psychiatric Publishing Textbook of Substance Abuse Treatment (4th ed.). American Psychiatric Publishing Inc. p. 58. ISBN 978-1-58562-276-4. https://books.google.com/books?id=6wdJgejlQzYC&pg=PA58. Retrieved 1 July 2024.
75. ↑ CCTP, Megan Tangradi MS, LPC, LCADC, CCS (2024-02-14). "Am I an Alcoholic? - Questions To Ask Yourself" (in en-US). https://achievewellnessnj.com/am-i-an-alcoholic-questions-to-ask-yourself/.
76. ↑ Dart, Richard C. (2003). Medical Toxicology (3rd ed.). Lippincott Williams & Wilkins. pp. 139–40. ISBN 978-0-7817-2845-4. https://books.google.com/books?id=qDf3AO8nILoC&pg=PA139.
77. ↑ "The pentylenetetrazol-like interoceptive stimulus produced by ethanol withdrawal is potentiated by bicuculline and picrotoxinin". Neuropsychopharmacology 2 (2): 115–22. June 1989. doi:10.1016/0893-133X(89)90014-6. PMID 2742726.
78. ↑ "Alcohol, neurotransmitter systems, and behavior". The Journal of General Psychology 133 (4): 329–35. October 2006. doi:10.3200/GENP.133.4.329-335. PMID 17128954.
79. ↑ 79.0 79.1 79.2 "Acute withdrawal, protracted abstinence and negative affect in alcoholism: are they linked?". Addiction Biology 15 (2): 169–84. April 2010. doi:10.1111/j.1369-1600.2009.00194.x. PMID 20148778.
80. ↑ Johnson, Bankole A. (2011). Addiction medicine: science and practice. New York: Springer. pp. 301–03. ISBN 978-1-4419-0337-2. https://books.google.com/books?id=zvbr4Zn9S9MC&pg=PA342.
81. ↑ "Chronic alcohol neuroadaptation and stress contribute to susceptibility for alcohol craving and relapse". Pharmacology & Therapeutics 129 (2): 149–71. February 2011. doi:10.1016/j.pharmthera.2010.09.007. PMID 20951730.
82. ↑ "Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar)". British Journal of Addiction 84 (11): 1353–7. November 1989. doi:10.1111/j.1360-0443.1989.tb00737.x. PMID 2597811. http://www.medicine.nevada.edu/residency/lasvegas/internalmed/documents/CIWA-ARBJA.pdf. Retrieved 25 October 2017.
83. ↑ 83.0 83.1 83.2 83.3 83.4 "Genetic and environmental influences on the development of alcoholism: resilience vs. risk". Annals of the New York Academy of Sciences 1094 (1): 193–201. December 2006. doi:10.1196/annals.1376.019. PMID 17347351. Bibcode: 2006NYASA1094..193E. https://zenodo.org/record/1235882. Retrieved 1 July 2024.
84. ↑ 84.0 84.1 84.2 84.3 84.4 84.5 84.6 84.7 "Alcohol Dehydrogenases, Aldehyde Dehydrogenases, and Alcohol Use Disorders: A Critical Review". Alcoholism: Clinical and Experimental Research 42 (12): 2281–2297. December 2018. doi:10.1111/acer.13904. PMID 30320893.
85. ↑ "Evidence for an interaction between age at first drink and genetic influences on DSM-IV alcohol dependence symptoms". Alcoholism: Clinical and Experimental Research 33 (12): 2047–56. December 2009. doi:10.1111/j.1530-0277.2009.01044.x. PMID 19764935.
86. ↑ "Adolescent Alcohol Exposure Persistently Impacts Adult Neurobiology and Behavior.". Pharmacol Rev 68 (4): 1074–1109. 2016. doi:10.1124/pr.115.012138. PMID 27677720.
87. ↑ "Impulsivity, frontal lobes and risk for addiction". Pharmacology, Biochemistry, and Behavior 93 (3): 237–47. September 2009. doi:10.1016/j.pbb.2009.04.018. PMID 19410598.
88. ↑ "Is cannabis use associated with an increased risk of onset and persistence of alcohol use disorders? A three-year prospective study among adults in the United States". Drug and Alcohol Dependence 161: 363–7. April 2016. doi:10.1016/j.drugalcdep.2016.01.014. PMID 26875671.
89. ↑ "Alcohol as a gateway drug: a study of US 12th graders". The Journal of School Health 82 (8): 371–9. August 2012. doi:10.1111/j.1746-1561.2012.00712.x. PMID 22712674. http://www.mamacultiva.org/wp-content/uploads/2015/pdf/A8 - Alcohol as a Gateway Drug A Study of US 12th Graders.pdf.
90. ↑ "Volume of World Beer Production". http://www.europeanbeerguide.net/eustats.htm#production.
91. ↑ Nelson, Max (2005). The Barbarian's Beverage: A History of Beer in Ancient Europe. Abingdon, Oxon: Routledge. p. 1. ISBN 978-0-415-31121-2. https://books.google.com/books?id=6xul0O_SI1MC&pg=PA1. Retrieved 21 September 2010.
92. ↑ Rudgley, Richard (1993). The Alchemy of Culture: Intoxicants in Society. London: British Museum Press. p. 411. ISBN 978-0-7141-1736-2. https://books.google.com/books?id=5baAAAAAMAAJ. Retrieved 13 January 2012.
93. ↑ Arnold, John P (2005). Origin and History of Beer and Brewing: From Prehistoric Times to the Beginning of Brewing Science and Technology. Cleveland, OH: BeerBooks. p. 411. ISBN 978-0-9662084-1-2. https://books.google.com/books?id=O5CPAAAACAAJ. Retrieved 13 January 2012.
94. ↑ Joshua J. Mark (2011). "Beer". Ancient History Encyclopedia. .
95. ↑ McFarland, Ben (2009). World's Best Beers: One Thousand. Sterling Publishing Company, Inc.. ISBN 978-1-4027-6694-7. https://books.google.com/books?id=SHh-4M_QxEsC&pg=PA10.
96. ↑ Shannon, Lisa M.; Havens, Jennifer R.; Oser, Carrie; Crosby, Rick; Leukefeld, Carl (March 2011). "Examining gender differences in substance use and age of first use among rural Appalachian drug users in Kentucky". The American Journal of Drug and Alcohol Abuse 37 (2): 98–104. doi:10.3109/00952990.2010.540282. ISSN 1097-9891. PMID 21142705.
97. ↑ Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington: American psychiatric association. 2013. ISBN 978-0-89042-555-8.
98. ↑ 98.0 98.1 98.2 "Transancestral GWAS of alcohol dependence reveals common genetic underpinnings with psychiatric disorders". Nature Neuroscience 21 (12): 1656–1669. December 2018. doi:10.1038/s41593-018-0275-1. PMID 30482948.
99. ↑ 99.0 99.1 99.2 "Genome-wide association study of alcohol consumption and use disorder in 274,424 individuals from multiple populations". Nature Communications 10 (1). April 2019. doi:10.1038/s41467-019-09480-8. PMID 30940813. Bibcode: 2019NatCo..10.1499K.
100. ↑ 100.0 100.1 "ALDH2, ADH1B, and ADH1C genotypes in Asians: a literature review". Alcohol Research & Health 30 (1): 22–7. 2007. PMID 17718397.
101. ↑ 101.0 101.1 "Variations in ADH and ALDH in Southwest California Indians". Alcohol Research & Health 30 (1): 14–7. 2007. PMID 17718395.
102. ↑ "Health-related effects of genetic variations of alcohol-metabolizing enzymes in African Americans". Alcohol Research & Health 30 (1): 18–21. 2007. PMID 17718396.
103. ↑ "Native Americans and alcohol: past, present, and future". The Journal of General Psychology 133 (4): 435–51. October 2006. doi:10.3200/GENP.133.4.435-451. PMID 17128961.
104. ↑ "A theory of reservation-dwelling American Indian alcohol use risk". Psychological Bulletin 133 (3): 395–418. May 2007. doi:10.1037/0033-2909.133.3.395. PMID 17469984.
105. ↑ "KLB is associated with alcohol drinking, and its gene product β-Klotho is necessary for FGF21 regulation of alcohol preference". Proceedings of the National Academy of Sciences of the United States of America 113 (50): 14372–14377. December 2016. doi:10.1073/pnas.1611243113. PMID 27911795. Bibcode: 2016PNAS..11314372S.
106. ↑ Zhou, Hang; Sealock, Julia M.; Sanchez-Roige, Sandra; Clarke, Toni-Kim; Levey, Daniel F.; Cheng, Zhongshan; Li, Boyang; Polimanti, Renato et al. (2020). "Genome-wide meta-analysis of problematic alcohol use in 435,563 individuals yields insights into biology and relationships with other traits". Nature Neuroscience 23 (7): 809–818. doi:10.1038/s41593-020-0643-5. ISSN 1097-6256. PMID 32451486.
107. ↑ 107.0 107.1 107.2 Kruman, Inna I.; Henderson, George I.; Bergeson, Susan E. (July 2012). "DNA damage and neurotoxicity of chronic alcohol abuse". Experimental Biology and Medicine 237 (7): 740–747. doi:10.1258/ebm.2012.011421. PMID 22829701.
108. ↑ 108.0 108.1 Cite error: Invalid `<ref>` tag; no text was provided for refs named `NIH2013`
109. ↑ "6C40.2 Alcohol dependence". September 2020. https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1580466198.
110. ↑ 110.0 110.1 "Lexicon of alcohol and drug terms published by the World Health Organization". World Health Organization. https://www.who.int/substance_abuse/terminology/who_lexicon/en/.
111. ↑ American Heritage Dictionaries (2006). The American Heritage dictionary of the English language (4 ed.). Boston: Houghton Mifflin. ISBN 978-0-618-70172-8. https://books.google.com/books?id=uPCFIQAACAAJ. "To use wrongly or improperly; misuse: abuse alcohol"
112. ↑ "Dietary Guidelines for Americans 2005". health.gov. 2005. http://www.health.gov/DIETARYGUIDELINES/dga2005/document/html/chapter9.htm. Dietary Guidelines
113. ↑ "Young Adult Drinking". Alcohol Alert (68). April 2006. http://pubs.niaaa.nih.gov/publications/aa68/aa68.htm. Retrieved 18 February 2013.
114. ↑ "Prevalence of alcohol dependence among US adult drinkers, 2009–2011". Preventing Chronic Disease 11: E206. November 2014. doi:10.5888/pcd11.140329. PMID 25412029.
115. ↑ "The definition of alcoholism. The Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism". JAMA 268 (8): 1012–1014. August 1992. doi:10.1001/jama.1992.03490080086030. PMID 1501306.
116. ↑ Alcoholism at the US National Library of Medicine Medical Subject Headings (MeSH)
117. ↑ ﻿Lexicon of alcohol and drug terms﻿ (Report). 1994. pp. 11–12. ISBN 92-4-154468-6.
118. ↑ 118.0 118.1 Thombs, Dennis L (1999). Introduction To Addictive Behaviors 2ed. London: The Guildford Press. pp. 64–65. https://books.google.com/books?id=Aze4azm9XkQCIntroduction.
119. ↑ Hasin, Deborah S.; O'Brien, Charles P.; Auriacombe, Marc; Borges, Guilherme; Bucholz, Kathleen; Budney, Alan; Compton, Wilson M.; Crowley, Thomas et al. (August 2013). "DSM-5 criteria for substance use disorders: recommendations and rationale". The American Journal of Psychiatry 170 (8): 834–851. doi:10.1176/appi.ajp.2013.12060782. ISSN 1535-7228. PMID 23903334.
120. ↑ First, Michael B.; Rebello, Tahilia J.; Keeley, Jared W.; Bhargava, Rachna; Dai, Yunfei; Kulygina, Maya; Matsumoto, Chihiro; Robles, Rebeca et al. (June 2018). "Do mental health professionals use diagnostic classifications the way we think they do? A global survey". World Psychiatry 17 (2): 187–195. doi:10.1002/wps.20525. ISSN 1723-8617. PMID 29856559. "... the ICD is required for administrative use in most countries in which documentation of diagnoses for clinical encounters is needed.".
121. ↑ 121.0 121.1 VandenBos, Gary R. (2006). APA dictionary of psychology. Washington, DC: American Psychological Association. ISBN 978-1-59147-380-0. https://books.google.com/books?id=OSoZAQAAIAAJ.
122. ↑ 122.0 122.1 "Diagnostic Criteria for Alcohol Abuse and Dependence – Alcohol Alert No. 30-1995". http://pubs.niaaa.nih.gov/publications/aa30.htm.
123. ↑ "How should we revise diagnostic criteria for substance use disorders in the DSM-V?". Journal of Abnormal Psychology 117 (3): 561–75. August 2008. doi:10.1037/0021-843X.117.3.561. PMID 18729609.
124. ↑ "Proposed Revision | APA DSM-5". http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=452#.
125. ↑ Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). Arlington, VA: American Psychiatric Association. 2013. p. 490. ISBN 978-0-89042-554-1. OCLC 830807378.
126. ↑ "A System to Convert ICD Diagnostic Codes for Alcohol Research". https://www.cdc.gov/mmwr/preview/mmwrhtml/00000324.htm.
127. ↑ "6C40.0 Episode of harmful use of alcohol". World Health Organization. April 2019. https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/766814084.
128. ↑ "6C40.1 Harmful pattern of use of alcohol". World Health Organization. April 2019. https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/714690795.
129. ↑ "6C40.2 Alcohol dependence". World Health Organization. April 2019. https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1580466198.
130. ↑ "Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement". JAMA 320 (18): 1899–1909. November 2018. doi:10.1001/jama.2018.16789. PMID 30422199.
131. ↑ "Recommendation: Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions | United States Preventive Services Taskforce" (in en). USPSTF. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/unhealthy-alcohol-use-in-adolescents-and-adults-screening-and-behavioral-counseling-interventions.
132. ↑ 132.0 132.1 132.2 132.3 132.4 132.5 132.6 Krist, Alex H.; Bradley, Katharine A. (May 2025). "Addressing Alcohol Use". New England Journal of Medicine 392 (17): 1721–1731. doi:10.1056/NEJMcp2402121. PMID 40305713.
133. ↑ Jenco, Melissa. "AAP report: Screen every adolescent for alcohol use". American Academy of Pediatrics. https://publications.aap.org/aapnews/article-abstract/36/9/21/636/AAP-report-Screen-every-adolescent-for-alcohol-use.
134. ↑ "Identifying and managing problem drinkers". Canadian Family Physician 42: 661–71. April 1996. PMID 8653034.
135. ↑ "Detecting alcoholism. The CAGE questionnaire". JAMA 252 (14): 1905–7. October 1984. doi:10.1001/jama.1984.03350140051025. PMID 6471323. Bibcode: 1984JAMA..252.1905E.
136. ↑ "CAGE questionnaire – screen for alcohol misuse". http://www.whoguidemhpcuk.org/downloads/primary_care/11-1_CAGE_questionnaire.pdf.
137. ↑ "The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies". Clinical and Investigative Medicine 30 (1): 33–41. 2007. doi:10.25011/cim.v30i1.447. PMID 17716538.
138. ↑ "Alcohol Dependence Data Questionnaire (SADD)". European Monitoring Centre for Drugs and Drug Addiction. 1983. http://www.emcdda.europa.eu/html.cfm/index3556EN.html.
139. ↑ "Michigan Alcohol Screening Test". The National Council on Alcoholism and Drug Dependence. http://www.ncadd-sfv.org/symptoms/mast_test.html.
140. ↑ Babor, Thomas F.; Higgins-Biddle, John C.; Saunders, John B.; Monteiro, Maristela G. (2001). "The Alcohol Use Disorders Identification Test; Guidelines for Use in Primary Care". World Health Organization. http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf.
141. ↑ "Detection of alcohol misusing patients in accident and emergency departments: the Paddington alcohol test (PAT)". Journal of Accident & Emergency Medicine 13 (5): 308–12. September 1996. doi:10.1136/emj.13.5.308. PMID 8894853.
142. ↑ "Urine as a biological specimen for forensic analysis of alcohol and variability in the urine-to-blood relationship". Toxicological Reviews 25 (1): 15–35. 2006. doi:10.2165/00139709-200625010-00002. PMID 16856767.
143. ↑ 143.00 143.01 143.02 143.03 143.04 143.05 143.06 143.07 143.08 143.09 143.10 143.11 143.12 Haber, Paul S. (16 January 2025). "Identification and Treatment of Alcohol Use Disorder". New England Journal of Medicine 392 (3): 258–266. doi:10.1056/NEJMra2306511. PMID 39813644.
144. ↑ 144.0 144.1 Carvalho, Andre F.; Heilig, Markus; Perez, Augusto; Probst, Charlotte; Rehm, Jürgen (2019-08-31). "Alcohol use disorders" (in English). The Lancet 394 (10200): 781–792. doi:10.1016/S0140-6736(19)31775-1. ISSN 0140-6736. PMID 31478502. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31775-1/abstract.
145. ↑ 145.0 145.1 Guido, Viel; Rafael, Boscolo-Berto; Giovanni, Cecchetto; Paolo, Fais; Alessandro, Nalesso; Davide, Ferrara, Santo (November 2012). "Phosphatidylethanol in Blood as a Marker of Chronic Alcohol Use: A Systematic Review and Meta-Analysis" (in en). International Journal of Molecular Sciences 13 (11). doi:10.3390/ijm. ISSN 1422-0067. https://www.mdpi.com/1422-0067/13/11/14788. Retrieved 22 September 2025.
146. ↑ Gough, Gina; Heathers, Laura; Puckett, Deonna; Westerhold, Chi; Ren, Xiaowei; Yu, Zhangsheng; Crabb, David W.; Liangpunsakul, Suthat (August 2015). "The Utility of Commonly Used Laboratory Tests to Screen for Excessive Alcohol Use in Clinical Practice". Alcoholism: Clinical and Experimental Research 39 (8): 1493–1500. doi:10.1111/acer.12780. PMID 26110815.
147. ↑ "Alcohol". World Health Organization. 2010. https://www.who.int/topics/alcohol_drinking/en/.
148. ↑ "Alcohol policy in the WHO European Region: current status and the way forward". World Health Organization. 12 September 2005. http://www.euro.who.int/document/mediacentre/fs1005e.pdf.
149. ↑ "The Effectiveness of Tax Policy Interventions for Reducing Excessive Alcohol Consumption and Related Harms". American Journal of Preventive Medicine 38 (2): 217–229. 2010. doi:10.1016/j.amepre.2009.11.005. ISSN 0749-3797. PMID 20117579.
150. ↑ "Adolescent cortical development: a critical period of vulnerability for addiction". Pharmacology, Biochemistry, and Behavior 86 (2): 189–99. February 2007. doi:10.1016/j.pbb.2006.12.001. PMID 17222895.
151. ↑ Gabbard, Glen O. (2001). Treatments of psychiatric disorders (3 ed.). Washington, DC: American Psychiatric Press. ISBN 978-0-88048-910-2. https://books.google.com/books?id=hLVrAAAAMAAJ.
152. ↑ Holleck, Jürgen L.; Merchant, Naseema; Gunderson, Craig G. (2019). "Symptom-Triggered Therapy for Alcohol Withdrawal Syndrome: a Systematic Review and Meta-analysis of Randomized Controlled Trials". Journal of General Internal Medicine 34 (6): 1018–1024. doi:10.1007/s11606-019-04899-7. ISSN 1525-1497. PMID 30937668.
153. ↑ Long, Drew; Long, Brit; Koyfman, Alex (2017). "The emergency medicine management of severe alcohol withdrawal". The American Journal of Emergency Medicine 35 (7): 1005–1011. doi:10.1016/j.ajem.2017.02.002. ISSN 1532-8171. PMID 28188055.
154. ↑ Hammond, Drayton A.; Rowe, Jordan M.; Wong, Adrian; Wiley, Tessa L.; Lee, Kristen C.; Kane-Gill, Sandra L. (2017). "Patient Outcomes Associated With Phenobarbital Use With or Without Benzodiazepines for Alcohol Withdrawal Syndrome: A Systematic Review". Hospital Pharmacy 52 (9): 607–616. doi:10.1177/0018578717720310. ISSN 0018-5787. PMID 29276297.
155. ↑ Brotherton, Amy L.; Hamilton, Eric P.; Kloss, H. Grace; Hammond, Drayton A. (2016). "Propofol for Treatment of Refractory Alcohol Withdrawal Syndrome: A Review of the Literature". Pharmacotherapy 36 (4): 433–442. doi:10.1002/phar.1726. ISSN 1875-9114. PMID 26893017.
156. ↑ Schmidt, Kyle J.; Doshi, Mitesh R.; Holzhausen, Jenna M.; Natavio, Allycia; Cadiz, Megan; Winegardner, Jim E. (2016). "Treatment of Severe Alcohol Withdrawal". The Annals of Pharmacotherapy 50 (5): 389–401. doi:10.1177/1060028016629161. ISSN 1542-6270. PMID 26861990.
157. ↑ Ferri, Marcia; Amato, Laura; Davoli, Marina (19 July 2006). "Alcoholics Anonymous and other twelve-step programmes for alcohol dependence". Cochrane Database of Systematic Reviews (3). doi:10.1002/14651858.CD005032.pub2. PMID 16856072. "no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems".
158. ↑ Kelly, John F; Humphreys, Keith; Ferri, Marica (2020-03-11). Cochrane Drugs and Alcohol Group. ed. "Alcoholics Anonymous and other 12-step programs for alcohol use disorder". The Cochrane Database of Systematic Reviews 2020 (3). doi:10.1002/14651858.CD012880.pub2. ISSN 1469-493X. PMID 32159228.
159. ↑ "Self-Help Groups for Alcohol Addiction". 2016. http://www.helpguide.org/articles/addiction/self-help-groups-for-alcohol-addiction.htm.
160. ↑ "APA Dictionary of Psychology". https://dictionary.apa.org/. "manualized therapy – interventions that are performed according to specific guidelines for administration, maximizing the probability of therapy being conducted consistently across settings, therapists, and clients. Also called manual-assisted therapy; manual-based therapy."
161. ↑ "Alcoholics Anonymous and other 12-step programs for alcohol use disorder". The Cochrane Database of Systematic Reviews 3 (3). March 2020. doi:10.1002/14651858.CD012880.pub2. PMID 32159228.
162. ↑ Ashton, Mike; Davies, Natalie. "'Dangerous data': drinking after dependence". https://findings.org.uk/PHP/dl.php?file=cont_drink.hot.
163. ↑ Henssler, Jonathan; Müller, Martin; Carreira, Helena; Bschor, Tom; Heinz, Andreas; Baethge, Christopher (August 2021). "Controlled drinking—non-abstinent versus abstinent treatment goals in alcohol use disorder: a systematic review, meta-analysis and meta-regression". Addiction 116 (8): 1973–1987. doi:10.1111/add.15329. ISSN 0965-2140. PMID 33188563.
164. ↑ "Recovery from DSM-IV alcohol dependence: United States, 2001–2002". Addiction 100 (3): 281–92. March 2005. doi:10.1111/j.1360-0443.2004.00964.x. PMID 15733237.
165. ↑ "Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up". Alcoholism: Clinical and Experimental Research 31 (12): 2036–45. December 2007. doi:10.1111/j.1530-0277.2007.00536.x. PMID 18034696. https://zenodo.org/record/1230663. Retrieved 1 July 2024.
166. ↑ Sobell, Mark B.; Sobell, Linda C. (1973). "Individualized behavior therapy for alcoholics". Behavior Therapy 4: 49–72. doi:10.1016/S0005-7894(73)80074-7.
167. ↑ "Controlled drinking by alcoholics? New findings and a reevaluation of a major affirmative study". Science 217 (4555): 169–75. July 1982. doi:10.1126/science.7089552. PMID 7089552. Bibcode: 1982Sci...217..169P.
168. ↑ "Alcoholism Study Under New Attack". The New York Times. 28 June 1982. https://www.nytimes.com/1982/06/28/us/alcholism-study-under-new-attack.html. "The new article will say that, 10 years later, four of the 20 had died from alcohol-related causes. Eight others were still drinking excessively, six were abstinent but in most cases after multiple hospitalizations, and one was drinking moderately. The alcohol dependence of that last case was also questioned. Another subject, who could not be found, was reported gravely disabled."
169. ↑ 169.0 169.1 "A 60-year follow-up of alcoholic men". Addiction 98 (8): 1043–51. August 2003. doi:10.1046/j.1360-0443.2003.00422.x. PMID 12873238.
170. ↑ "Effectiveness and treatment moderators of internet interventions for adult problem drinking: An individual patient data meta-analysis of 19 randomised controlled trials". PLOS Medicine 15 (12). December 2018. doi:10.1371/journal.pmed.1002714. PMID 30562347.
171. ↑ "Alcohol and Other Drugs". Alcohol Alert (National Institute on Alcohol Abuse and Alcoholism) (76). July 2008. http://pubs.niaaa.nih.gov/publications/AA76/AA76.htm. Retrieved 11 July 2013.
172. ↑ "The neurobiology, clinical efficacy and safety of acamprosate in the treatment of alcohol dependence". Expert Opinion on Drug Safety 9 (1): 177–88. January 2010. doi:10.1517/14740330903512943. PMID 20021295.
173. ↑ "Acamprosate: a prototypic neuromodulator in the treatment of alcohol dependence". CNS & Neurological Disorders Drug Targets 9 (1): 23–32. March 2010. doi:10.2174/187152710790966641. PMID 20201812.
174. ↑ "Acamprosate for alcohol dependence". The Cochrane Database of Systematic Reviews 128 (9). September 2010. doi:10.1002/14651858.CD004332.pub2. PMID 20824837.
175. ↑ 175.0 175.1 175.2 175.3 "Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis". JAMA 311 (18): 1889–900. May 2014. doi:10.1001/jama.2014.3628. PMID 24825644.
176. ↑ "Opioid antagonists for pharmacological treatment of alcohol dependence – a critical review". Current Drug Abuse Reviews 1 (3): 280–91. November 2008. doi:10.2174/1874473710801030280. PMID 19630726.
177. ↑ "Repurposing drugs for treatment of alcohol use disorder". International Review of Neurobiology. 175. Elsevier. 2024. pp. 153–185. doi:10.1016/bs.irn.2024.02.002. ISBN 978-0-443-14164-5. https://linkinghub.elsevier.com/retrieve/pii/S0074774224000229. Retrieved 2025-08-03.
178. ↑ Gitlow, Stuart (2006). Substance Use Disorders: A Practical Guide (2nd ed.). Lippincott Williams & Wilkins. pp. 52, 103–21. ISBN 978-0-7817-6998-3. https://books.google.com/books?id=rbrSdWVerBUC. Retrieved 1 July 2024.
179. ↑ "The relationship between anxiety disorders and alcohol use disorders: a review of major perspectives and findings". Clinical Psychology Review 20 (2): 149–71. March 2000. doi:10.1016/S0272-7358(99)00027-6. PMID 10721495.
180. ↑ "Identifying and treating patients with alcohol-related problems". CMAJ 162 (12): 1705–8. June 2000. PMID 10870503.
181. ↑ 181.0 181.1 181.2 181.3 181.4 "Pharmacotherapy of alcoholism – an update on approved and off-label medications". Expert Opinion on Pharmacotherapy 18 (12): 1187–1199. August 2017. doi:10.1080/14656566.2017.1349098. PMID 28658981.
182. ↑ "Review: Pharmacogenetics of alcoholism treatment: Implications of ethnic diversity". The American Journal on Addictions 26 (5): 516–525. August 2017. doi:10.1111/ajad.12463. PMID 28134463.
183. ↑ 183.0 183.1 "Anticonvulsants for the treatment of alcohol withdrawal syndrome and alcohol use disorders". CNS Drugs 29 (4): 293–311. April 2015. doi:10.1007/s40263-015-0240-4. PMID 25895020.
184. ↑ 184.0 184.1 "Anticonvulsants for alcohol dependence". The Cochrane Database of Systematic Reviews 2014 (2). February 2014. doi:10.1002/14651858.CD008544.pub2. PMID 24523233. "At the current stage of research, evidence supporting the clinical use of anticonvulsants to treat alcohol dependence is insufficient. Results are conditioned by heterogeneity and by the low number and quality of studies comparing anticonvulsants versus other medications. The uncertainty associated with these results leaves to clinicians the need to balance the possible benefits/risks of treatment with anticonvulsants versus other medications as supported by evidence of efficacy.".
185. ↑ Olmsted CL, Kockler DR (October 2008). "Topiramate for alcohol dependence". Ann Pharmacother 42 (10): 1475–80. doi:10.1345/aph.1L157. ISSN 1060-0280. PMID 18698008.
186. ↑ Kenna, GA.; Lomastro, TL.; Schiesl, A.; Leggio, L.; Swift, RM. (May 2009). "Review of topiramate: an antiepileptic for the treatment of alcohol dependence". Curr Drug Abuse Rev 2 (2): 135–42. doi:10.2174/1874473710902020135. PMID 19630744.
187. ↑ Leggio, L; Garbutt, JC; Addolorato, G (March 2010). "Effectiveness and safety of baclofen in the treatment of alcohol dependent patients.". CNS & Neurological Disorders Drug Targets 9 (1): 33–44. doi:10.2174/187152710790966614. PMID 20201813.
188. ↑ Liu, Jia; Wang, Lu-Ning (20 August 2017). "Baclofen for alcohol withdrawal". The Cochrane Database of Systematic Reviews 8 (8). doi:10.1002/14651858.CD008502.pub5. ISSN 1469-493X. PMID 28822350.
189. ↑ Sullivan, Kaitlin (24 August 2022). "Does psilocybin change your brain? How the ingredient in magic mushrooms may ease addiction". NBC News. https://www.nbcnews.com/health/mental-health/psilocybin-mushroom-help-people-alcohol-use-disorder-rcna44180.
190. ↑ Bogenschutz (24 August 2022). "Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder – A Randomized Clinical Trial". JAMA Psychiatry 79 (10): 953–962. doi:10.1001/jamapsychiatry.2022.2096. PMID 36001306.
191. ↑ "Low-dose diazepam primes motivation for alcohol and alcohol-related semantic networks in problem drinkers". Behavioural Pharmacology 15 (7): 503–12. November 2004. doi:10.1097/00008877-200411000-00006. PMID 15472572.
192. ↑ "Dependence on legal psychotropic drugs among alcoholics". Alcohol and Alcoholism 38 (6): 613–8. November 2003. doi:10.1093/alcalc/agg123. PMID 14633651.
193. ↑ "Alcohol consumption per person". https://ourworldindata.org/grapher/total-alcohol-consumption-per-capita-litres-of-pure-alcohol.
194. ↑ "Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions". Archives of General Psychiatry 64 (7): 830–42. July 2007. doi:10.1001/archpsyc.64.7.830. PMID 17606817.
195. ↑ "alcoholism". Encyclopædia Britannica. 2010. https://www.britannica.com/EBchecked/topic/13448/alcoholism.
196. ↑ 196.0 196.1 "Alcohol dependence prevalence in England". 18 March 2021. https://www.gov.uk/government/publications/alcohol-dependence-prevalence-in-england.
197. ↑ The Human Atlas of Europe. Bristol: Policy Press. 2017. p. 73. ISBN 978-1-4473-1354-0. https://books.google.com/books?id=z1ClDgAAQBAJThe.
198. ↑ "Acute alcohol intoxication". European Journal of Internal Medicine 19 (8): 561–7. December 2008. doi:10.1016/j.ejim.2007.06.033. PMID 19046719.
199. ↑ Volkow, Nora. "Science of Addiction". American Medical Association. http://www.ama-assn.org/ama1/pub/upload/mm/388/sci_drug_addiction.pdf.
200. ↑ "The genetics of alcohol dependence". Current Psychiatry Reports 8 (2): 151–7. April 2006. doi:10.1007/s11920-006-0015-1. PMID 16539893.
201. ↑ "[Alcoholism—how it affects health and working capacity]". Arhiv Za Higijenu Rada I Toksikologiju 57 (4): 413–26. December 2006. PMID 17265681.
202. ↑ American Psychiatric Association practice guidelines for the treatment of psychiatric disorders. Arlington, VA: American Psychiatric Association. 2006. p. 1346. ISBN 978-0-89042-385-1. https://books.google.com/books?id=zql0AqtRSrYC&pg=PA1346.
203. ↑ O'Connor, Rory; Sheehy, Noel (29 January 2000). Understanding suicidal behaviour. Leicester: BPS Books. pp. 33–37. ISBN 978-1-85433-290-5. https://books.google.com/books?id=79hEYGdDA3oC. Retrieved 1 July 2024.
204. ↑ The National Institute on Alcohol Abuse and Alcoholism; U.S. Department of Health and Human Services, NIH News (18 January 2005). "2001–2002 Survey Finds That Many Recover From Alcoholism". National Institutes of Health. http://www.nih.gov/news/pr/jan2005/niaaa-18.htm.
205. ↑ 205.0 205.1 205.2 Jean-Marie Coste; Tristan Coste (December 2025). "Regard historique sur l'évolution de l'accompagnement et des soins en alcoologie [A historical overview of developments in alcoholism support and treatment]" (in fr). Dépendances (Addiction Switzerland) (83): 3-6. ISSN 1422-3368.
206. ↑ Peters, Uwe Henrik (2007). Lexikon Psychiatrie, Psychotherapie, Medizinische Psychologie. Urban Fischer bei Elsev. ISBN 978-3-437-15061-6. https://books.google.com/books?id=qY6_DQAAQBAJ.
207. ↑ Valverde, Mariana (1998). Diseases of the Will. Cambridge: Cambridge University Press. p. 48. ISBN 978-0-521-64469-3. https://books.google.com/books?id=Kl5ugmvDgH0C&pg=PA4848. Retrieved 1 July 2024.
208. ↑ Tracy, Sarah J. (2005). Alcoholism in America: from reconstruction to prohibition. Baltimore: Johns Hopkins University Press. pp. 31–52. ISBN 978-0-8018-8119-0. https://books.google.com/books?id=JkYyd4qmme0C&pg=PA31.
209. ↑ "Did prohibition really work? Alcohol prohibition as a public health innovation". American Journal of Public Health 96 (2): 233–43. February 2006. doi:10.2105/AJPH.2005.065409. PMID 16380559. "Nevertheless, once Prohibition became the law of the land, many citizens decided to obey it. Referendum results in the immediate post-Volstead period showed widespread support, and the Supreme Court quickly fended off challenges to the new law. Death rates from cirrhosis and alcoholism, alcoholic psychosis hospital admissions, and drunkenness arrests all declined steeply during the latter years of the 1910s, when both the cultural and the legal climate were increasingly inhospitable to drink, and in the early years after National Prohibition went into effect.".
210. ↑ Potter, James V. (2008). Substances of Abuse. 2. AFS Publishing Co. pp. 1–13. ISBN 978-1-930327-46-7. https://books.google.com/books?id=WU73eJAIDI4C&pg=PA1.
211. ↑ 211.0 211.1 211.2 211.3 Dudley, Robert (March 2000). "Evolutionary Origins of Human Alcoholism in Primate Frugivory". The Quarterly Review of Biology 75 (1): 3–15. doi:10.1086/393255. ISSN 0033-5770. PMID 10721531. https://www.journals.uchicago.edu/doi/10.1086/393255.
212. ↑ 212.0 212.1 212.2 Clites, Benjamin L.; Hofmann, Hans A.; Pierce, Jonathan T. (2023). "The Promise of an Evolutionary Perspective of Alcohol Consumption". Neuroscience Insights 18. doi:10.1177/26331055231163589. ISSN 2633-1055. PMID 37051560.
213. ↑ 213.0 213.1 Clites, Benjamin L; Hofmann, Hans A; Pierce, Jonathan T (2023). "The Promise of an Evolutionary Perspective of Alcohol Consumption". Neuroscience Insights 18. doi:10.1177/26331055231163589. ISSN 2633-1055. PMID 37051560.
214. ↑ 214.0 214.1 214.2 214.3 214.4 214.5 Dudley, Robert (2002). "Fermenting fruit and the historical ecology of ethanol ingestion: is alcoholism in modern humans an evolutionary hangover?" (in en). Addiction 97 (4): 381–388. doi:10.1046/j.1360-0443.2002.00002.x. ISSN 1360-0443. PMID 11964055. https://onlinelibrary.wiley.com/doi/10.1046/j.1360-0443.2002.00002.x.
215. ↑ Gerald, Melissa S.; Higley, J. Dee (2002). "Evolutionary underpinnings of excessive alcohol consumption" (in en). Addiction 97 (4): 415–425. doi:10.1046/j.1360-0443.2002.00023.x. ISSN 1360-0443. PMID 11964058. https://onlinelibrary.wiley.com/doi/10.1046/j.1360-0443.2002.00023.x.
216. ↑ "Alcohol and health". World Health Organization. https://www.who.int/substance_abuse/infographic_alcohol_2018.pdf?ua=1.
217. ↑ Streissguth, Ann Pytkowicz (2018). Fetal alcohol syndrome: a guide for families and communities. Baltimore: Paul H Brookes Pub.. ISBN 978-1-55766-283-5. https://books.google.com/books?id=kptHAAAAMAAJ. Retrieved 1 July 2024.
218. ↑ Gerberding, Julie Louise; Cordero, José; Floyd, R. Louise (May 2005). "Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis". US Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/fasd/documents/FAS_guidelines_accessible.pdf.
219. ↑ "Global Status Report on Alcohol 2004". World Health Organization. https://www.who.int/substance_abuse/publications/global_status_report_2004_overview.pdf.
220. ↑ "Economic cost of alcohol consumption". World Health Organization Global Alcohol Database. https://www.who.int/globalatlas/dataQuery/objectInterface.asp?objID=359&boCat=&p=null&lvl=0&catID=520700000000&level=2.
221. ↑ "Q&A: The costs of alcohol". BBC. 19 September 2003. https://news.bbc.co.uk/2/hi/health/3122244.stm.
222. ↑ "Economic costs of excessive alcohol consumption in the U.S., 2006". American Journal of Preventive Medicine 41 (5): 516–24. November 2011. doi:10.1016/j.amepre.2011.06.045. PMID 22011424. http://www.sertox.com.ar/img/item_full/Bouchery_2011.pdf. Retrieved 12 December 2017.
223. ↑ "hit rock bottom". https://idioms.thefreedictionary.com/hit+rock+bottom.
224. ↑ 224.0 224.1 224.2 "Identifying 'Hitting Bottom' Among Individuals with Alcohol Problems: Development and Evaluation of the Noteworthy Aspects of Drinking Important to Recovery (NADIR)". Substance Use & Misuse 52 (12): 1602–1615. October 2017. doi:10.1080/10826084.2017.1293104. PMID 28557550.
225. ↑ "Treatment of Alcohol Addiction". British Medical Journal 2 (5455): 184–5. July 1965. doi:10.1136/bmj.2.5455.184. PMID 20790596.
226. ↑ "World/Global Alcohol/Drink Consumption". Finfacts Ireland. 2009. http://www.finfacts.ie/Private/bestprice/alcoholdrinkconsumptionpriceseurope.htm.
227. ↑ Stivers, Richard (2000). Hair of the dog: Irish drinking and its American stereotype. New York: Continuum. ISBN 978-0-8264-1218-8. https://books.google.com/books?id=MH3aAAAAMAAJ.
228. ↑ "Alcohol abuse and related factors in Asia". International Review of Psychiatry 20 (5): 425–33. October 2008. doi:10.1080/09540260802344075. PMID 19012127.
229. ↑ "Drinking culture of elderly Korean immigrants in Canada: a focus group study". Journal of Cross-Cultural Gerontology 24 (4): 339–53. December 2009. doi:10.1007/s10823-009-9104-z. PMID 19823926.
230. ↑ "Psychoactive agents and Native American spirituality: Past and present". Contemporary Justice Review 11 (2): 155–63. 2008. doi:10.1080/10282580802058270.

## External links

Classification|

* ICD-11: 6C40.2
* ICD-10: F10.2
* ICD-9-CM: 303
* OMIM: 103780
* MeSH: D000437

|

External resources|

* MedlinePlus: 000944
* eMedicine: article/285913

* v
* t
* e

Reinforcement disorders: Addiction and Dependence

Addiction|

| Drug|

* Alcoholism
* Amphetamine
* Cocaine
* Methamphetamine
* Methylphenidate
* Nicotine
* Opioid

|

Behavioral|

* Financial
* Gambling
* Shopping
* Palatable food
* Sex-related
* Intercourse
* Pornography
* Video game addiction
* Digital media addictions

Cellular
mechanisms|

* Transcriptional
* ΔFosB
* c-Fos
* Cdk5
* CREB
* GluR2
* NF-κB

* Epigenetic
* G9a
* G9a-like protein
* HDAC1
* HDAC2
* HDAC3
* HDAC4
* HDAC5
* HDAC9
* HDAC10
* SIRT1
* SIRT2
* ...

Dependence|

| Concepts|

* Physical dependence
* Psychological dependence
* Withdrawal

|

Disorders|

* Drugs
* Alcoholism
* Amphetamine
* Barbiturate
* Benzodiazepine
* Caffeine
* Cannabis
* Cocaine
* Nicotine
* Opioid
* Non-drug stimuli
* Tanning dependence

Treatment and management|

| Detoxification|

* Alcohol detoxification
* Drug detoxification

|

Behavioral therapies|

* Cognitive behavioral therapy
* Relapse prevention
* Contingency management
* Community reinforcement approach and family training
* Motivational enhancement therapy
* Motivational interviewing
* Motivational therapy
* Physical exercise

Treatment programs|

* Drug rehab
* Residential treatment center
* Heroin-assisted treatment
* Intensive outpatient program
* Methadone maintenance
* Smoking cessation
* Nicotine replacement therapy
* Tobacco cessation clinics in India
* Twelve-step program

Support groups|

* Addiction recovery groups
* List of twelve-step groups
* NoFap

Harm reduction|

* Category:Harm reduction
* Drug checking
* Reagent testing
* Low-threshold treatment programs
* Managed alcohol program
* Moderation Management
* Needle exchange program
* Responsible drug use
* Stimulant maintenance
* Supervised injection site
* Tobacco harm reduction

See also|

* Addiction medicine
* Category:Addiction
* Discrimination against drug addicts
* Dopamine dysregulation syndrome
* Cognitive control
* Inhibitory control
* Motivational salience
* Incentive salience
* Sober companion

* Category

* v
* t
* e

Alcohol and health

Alcohol use|

| Alcohol-related crimes|

* Drunk drivers
* Alcohol-related traffic crashes in the United States)
* Driving under the influence (DUI)
* Drunk driving in the United States
* Public intoxication
* Rum-running
* Adulterated moonshine/Denatured alcohol
* List of methanol poisoning incidents

|

Alcoholism|

Note: see Template:Psychoactive substance use for diagnoses, and Category:Psychiatric instruments: alcohol abuse for treatment evaluation instruments.

* Alcohol and Native Americans
* Alcoholism in adolescence
* Alcoholism in family systems
* Collaborative Study on the Genetics of Alcoholism
* College student alcoholism
* Disease theory of alcoholism
* High-functioning alcoholic (HFA)
* Seeing pink elephants

Chemistry|

* Beer chemistry
* Congener (Alcohol congener analysis)
* Ethanol (Blood alcohol content, Breathalyzer)
* Fusel alcohol
* Wine chemistry

Effects|

* Effects of alcohol consumption
* short-term
* long-term
* On memory
* Subjective response to alcohol

Interactions|

* Aging
* Brain
* Cancer
* breast cancer
* Cortisol
* Pregnancy
* Sleep
* Tolerance/intolerance
* Weight
* Beverage-specific
* Beer: Potomania
* Red wine: Red wine headache

Social issues|

* Alcohol advertising
* on college campuses
* Sex
* Alcohol myopia
* Alcohol abuse among college students
* Binge drinking
* Epidemiology
* Blackout (alcohol-related amnesia)
* Blackout Wednesday
* Drinking games (list) / pregaming
* Drinking in public
* Drunk dialing
* Drunk walking
* Drunkorexia
* Dry drunk
* French paradox
* Hair of the dog
* Nightcap
* Passive drinking
* Binge drinking devices
* Beer bong
* Yard of ale
* Routes of administration
* Alcohol enema
* Alcohol inhalation
* Sconcing
* Surrogate alcohol
* Related issues
* Balconing
* Suicide

History|

* Dionysian Mysteries
* Dipsomania
* Gin Craze
* List of deaths through alcohol
* Rum ration
* Speakeasy

General|

* Beer day
* Drinking culture
* Apéritif and digestif
* Hangover remedies
* Health effects of wine
* Wine and food matching
* Long-distance race involving alcohol
* List of countries by alcohol consumption per capita
* Alcohol consumption by youth in the United States
* Nip joint

Alcohol control|

| Alcohol law|

* Administrative license suspension (ALS)
* Alcohol packaging warning messages
* Drunk driving law by country
* DWI court
* Field sobriety testing
* Hip flask defence
* Ignition interlock device
* Legal drinking age
* Legal drinking age controversy in the United States
* Underage drinking in America
* List of alcohol laws of the United States

|

Alcohol prohibition|

* List of countries with alcohol prohibition
* Neo-prohibitionism
* Temperance movement

Sobriety|

* Alcohol detoxification
* Alcohol-free zone
* United States open-container laws
* Designated driver
* Alcohol rehabilitation
* Drunk tank
* Managed alcohol program
* Non-alcoholic drink
* List of non-alcoholic cocktails
* List of non-alcoholic mixed drinks
* Non-alcoholic spritzer
* Non-alcoholic malt drinks
* Teetotalism
* Temperance bar
* Twelve-step groups
* Al-Anon/Alateen
* Alcoholics Anonymous (AA):
* Adult Children of Alcoholics (ACA)

Alcohol limitation|

* 0-0-1-3
* Alcohol education
* Alcohol server training
* FRAMES
* Dry January
* Foundation for Advancing Alcohol Responsibility
* Campaigns
* Get Your Sexy Back
* Low-alcohol drinks
* Fermented tea
* Low-alcohol beer
* Low-alcoholic malt drinks
* Small beer
* Measurement
* Alcoholic spirits measure
* Standard drink
* Recommended maximum intake of alcoholic beverages

Addiction medicine|

* Disulfiram-like drugs: disulfiram, calcium carbimide, cyanamide. [[Chemistry:Sulfonic Sulfonic acid]]s: Acamprosate

Religion and alcohol|

* Christian views on alcohol
* alcohol in the Bible
* Islam and alcohol

History|

* Bratt System

Related|

* Index of alcohol-related articles
* Austrian syndrome
* Ban on caffeinated alcoholic beverages
* Brief intervention
* Gateway drug effect
* Mood disorder
* Non-alcoholic fatty liver disease
* Self-medication
* Spins
* Sober companion
* Sober living houses
* Sobering center
* Town drunk

* Category

* v
* t
* e

Psychoactive substance-related disorder (F10–F19, 291–292; 303–305)

General|

* SID
* Substance intoxication / Drug overdose
* Substance-induced psychosis
* Withdrawal:
* Craving
* Neonatal withdrawal
* Post-acute-withdrawal syndrome (PAWS)
* SUD
* Substance abuse / Substance-related disorders
* Physical dependence / Psychological dependence / Substance dependence

Combined
substance use|

* SUD
* Polysubstance dependence
* SID
* Combined drug intoxication (CDI)

Alcohol|

| SID|

| Cardiovascular diseases|

* Alcoholic cardiomyopathy
* Alcohol flush reaction

|

Gastrointestinal diseases|

* Alcoholic liver disease (ALD):
* Alcoholic hepatitis
* Auto-brewery syndrome

Endocrine diseases|

* Alcoholic ketoacidosis (AKA)

Nervous
system diseases|

* Alcohol-related dementia (ARD)
* Alcohol intoxication
* Hangover

Neurological
disorders|

* Alcoholic hallucinosis
* Alcoholic polyneuropathy
* Alcohol-related brain damage
* Alcohol withdrawal syndrome:
* Alcoholic hallucinosis
* Delirium tremens (DTs)
* Fetal alcohol spectrum disorder (FASD)
* Fetal alcohol syndrome (FAS)
* Korsakoff syndrome
* Korsakoff psychosis
* Positional alcohol nystagmus (PAN)
* Wernicke–Korsakoff syndrome (WKS)
* Wernicke encephalopathy (WE)

Respiratory tract diseases|

* Alcohol-induced respiratory reactions
* Alcoholic lung disease

SUD|

* Alcoholism (alcohol use disorder (AUD))
* Binge drinking

Caffeine|

* SID
* Caffeine-induced anxiety disorder
* Caffeine-induced sleep disorder
* Caffeinism
* SUD
* Caffeine dependence

Cannabis|

* SID
* Cannabinoid hyperemesis syndrome (CHS)
* SUD
* Amotivational syndrome
* Cannabis use disorder (CUD)
* Synthetic cannabinoid use disorder

Cocaine|

* SID
* Cocaine intoxication
* Prenatal cocaine exposure (PCE)
* SUD
* Cocaine dependence

Hallucinogen|

* SID
* Acute intoxication from hallucinogens (bad trip)
* Hallucinogen persisting perception disorder (HPPD)

Nicotine|

* SID
* Nicotine poisoning
* Nicotine withdrawal
* SUD
* Nicotine dependence

Opioids|

* SID
* Opioid overdose
* SUD
* Opioid use disorder (OUD)

Sedative /
hypnotic|

* SID
* Kindling (sedative–hypnotic withdrawal)
* benzodiazepine: SID
* Benzodiazepine overdose
* Benzodiazepine withdrawal
* SUD
* Benzodiazepine use disorder (BUD)
* Benzodiazepine dependence
* barbiturate: SID
* Barbiturate overdose
* SUD
* Barbiturate dependence

Stimulants|

* SID
* Stimulant psychosis
* amphetamine: SUD
* Amphetamine dependence

Volatile
solvent|

* SID
* Sudden sniffing death syndrome (SSDS)
* Toluene toxicity
* SUD
* Inhalant abuse

* v
* t
* e

Alcoholics Anonymous

* History
* Effectiveness

Concepts|

* Twelve Steps
* Twelve Traditions
* Higher Power
* Serenity Prayer

Literature|

* The Big Book
* Twelve Steps and Twelve Traditions
* The Little Red Book
* Day by Day

People|

* Bill W.
* Dr. Bob
* Jim Burwell
* Sister Ignatia
* Marty Mann
* Carl Jung
* Lois W.
* William Duncan Silkworth
* Rowland Hazard III
* Ebby Thacher

Related|

* Al-Anon/Alateen
* Alcoholism
* Bill Wilson House
* Disease theory of alcoholism
* Hazelden Foundation
* The Oxford Group
* Stepping Stones
* Charles B. Towns

Drama|

* Bill W. and Dr. Bob
* My Name Is Bill W.
* When Love Is Not Enough: The Lois Wilson Story
* Bill W. (2012)

* Category

0.00

(0 votes)

Original source: https://en.wikipedia.org/wiki/Alcoholism. Read more

|

Retrieved from "https://handwiki.org/wiki/index.php?title=Medicine:Alcoholism&oldid=4238579"
*[c.]: circa
*[v]: View this template
*[t]: Discuss this template
*[e]: Edit this template