Alcoholism, Alcohol Dependence, Alcohol Ketoacidosis, Delirium Tremens (DTs) . . .

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ALCOHOLISM

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WHAT IS ALCOHOLISM? The severity of alcohol problems vary from mild to life threatening and affect the individual drinking the alcohol, the person's family, and society in numerous unfortunate ways. Despite growing prevalence and focus on drugs such as cocaine and marijuana, alcohol remains the number one drug problem in the United States. According to community surveys, over 13% of adults in the United States will experience alcohol abuse or dependence (also referred to as alcoholism) at some point in their lives.
WHAT CAUSES ALCOHOLISM? The cause of alcoholism is not well established. There is growing evidence for genetic and biologic predispositions for this disease, but this research is controversial. Studies examining adopted children have shown that children of alcoholic biological parents have an increased risk of becoming alcoholics. Relatively recent research has implicated a gene (D2 dopamine receptor gene) that, when inherited in a specific form, might increase a person's chance of developing alcoholism.
WHO ARE AT MOST RISK? Twice as many men are alcoholics. And 10-23% of alcohol-consuming individuals are considered alcoholics. Usually, a variety of factors contribute to the development of a problem with alcohol. Social factors such as the influence of family, peers, and society, and the availability of alcohol, and psychological factors such as elevated levels of stress, inadequate coping mechanisms, and reinforcement of alcohol use from other drinkers can contribute to alcoholism. Also, the factors contributing to initial alcohol use may vary from those maintaining it, once the disease develops.
HOW DANGEROUS IS ALCOHOL WITHDRAWL? VERY DANGEROUS! Someone who is "dependent" on alcohol could actually die going through the withdrawal process. ANYONE withdrawaling from alcohol should be supervised by a healthcare professional. Withdrawal, for those physically dependent on alcohol, is much more dangerous than withdrawal from heroin or other narcotic drugs.
WHAT IS ALCOHOL ABUSE? Alcohol abuse is excessive or problematic use with ONE OR MORE of the following:

Legal problems

Failure to fulfill major obligations at work, school, or home

Recurrent use in situations where it is hazardous (such as driving a car or operating machinery)

Continued use of alcohol despite having social, family, or interpersonal problems caused by or worsened by drinking

WHAT IS ALCOHOL DEPENDENCE?

Inability to cut down or stop

Spending a great deal of time drinking or recovering from its effects

Drinking more alcohol or drinking over a longer period of time than intended (loss of control)

Tolerance changes (need for more to achieve desired effect, or achieving the effect with lesser amounts of alcohol)

Giving up important social, occupational, or recreational activities

Continuing to drink despite knowing alcohol use has caused or worsened problems

Withdrawal symptoms following a reduction or cessation of drinking (such as sweating, rapid pulse, tremors, insomnia, nausea, vomiting, hallucinations, agitation, anxiety, or seizures) or using alcohol to avoid withdrawal symptoms (for example, early morning drinking)

WHAT ARE THE SIGNS AND SYMPTOMS OF ALCOHOL WITHDRAWAL? Alcohol withdrawal requires EMERGENCY treatment. When withdrawing from alcohol, a person classically goes through 4 phases: tremulousness (the shakes), seizures, hallucinations, and delirium tremens (DTs), which are outlined below:

TREMULOUSNESS: The person will exhibit a tremor of his or her hands and legs. This can be seen if the person extends his or her hand and tries to hold it still. This symptom is often accompanied by anxiety and restlessness.

SEIZURES: Seizures often follow the tremulous stage. They are commonly generalized seizures during which the entire body shakes uncontrollably and the person loses consciousness. Seizures occur in up to 25% of people withdrawing from alcohol. If you see someone having a seizure, attempt to lay the person on one side so they don't inhale any vomit or secretions into their lungs. If possible, protect the person's head or other body parts from knocking uncontrollably onto the floor or against other potentially harmful objects. Do not place anything inside the person's mouth while they are having a seizure.

HALLUCINATIONS/FORMICATION: Hallucinations affect about 25% of people undergoing major alcohol withdrawal. Visual hallucinations are the most common type of hallucination experienced during alcohol withdrawal. People will classically "see" insects or worms crawling on walls or over their skin. Often this is associated with the tactile (feeling) hallucinations in which alcoholics think they feel insects crawling on their skin. This phenomenon is called formication. Auditory (hearing) hallucinations can also occur during withdrawal, although less commonly than the other types of hallucinations.

DELIRIUM TREMENS (DTs): The most dangerous stage of alcohol withdrawal is called delirium tremens (DTs). About 5% of people withdrawing from alcohol experience DTs. This condition occurs about 48 - 72 hours after drinking stops. The hallmark of this stage is profound delirium (confusion). People are awake, but thoroughly confused. This is accompanied by agitation, delusions, sweating, hallucinations, rapid heart rate, and high blood pressure. This is a true emergency. Studies have shown that death will occur in about 35% of these people if they are not treated promptly. Even with appropriate medical treatment, this condition is associated with a high death rate.

WHAT IS ALCOHOLIC KETOACIDOSIS (AKA)? Alcoholic ketoacidosis (AKA) is another condition for which emergency medical treatment should be sought. AKA often starts within 2 - 4 days after an alcoholic has stopped consuming alcohol, fluids, and food, often because of gastritis or pancreatitis. Not uncommonly, AKA and alcohol withdrawal syndromes are seen at the same time. AKA is characterized by nausea, vomiting, abdominal pain, dehydration, and an acetone-like odor on the person's breath. This occurs when the alcoholic has become depleted of carbohydrate fuel stores and water. Therefore, the body begins to metabolize fat and protein into ketone bodies for energy. Ketone bodies are acids that accumulate in the blood changing its acidity and causing the person to feel even sicker, thus perpetuating a vicious cycle.
WHAT ELSE IS ASSOCIATED WITH ALCOHOLISM? Alcoholism is often associated with other psychiatric disorders such as anxiety, depression, and psychosis. This psychiatric illness, often combined with a reduced level of sound judgment while intoxicated, leads to suicides, suicide attempts, and suicidal gestures by alcoholics. Obviously, a person who has attempted suicide, or is believed to be in serious or imminent danger of committing suicide, should be taken quickly to the Emergency Department.
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