Over 20% Lifetime Risk Of Men Developing Alcohol Dependence Disorder

January 26, 2009 at 11:00 am Leave a comment


The lifetime risk of alcohol-use disorders for men is more than 20%, with a risk of about 15% for alcohol abuse and 10% for alcohol dependence. For women*, the lifetime risk is less than half that of men, at 8-10%. And while there is a widespread public perception that treatment simply does not work, some strategies are highly effective – and recovery can begin with a trip to your doctor. The issues around this contentious subject are discussed in a Seminar published Online First and in an upcoming edition of The Lancet, written by Dr Marc Schuckit, VA San Diego Healthcare System, and University of California, San Diego, USA.




Alcohol-use disorders are common in all developed countries, and are more prevalent in men than women, with lower, but still substantial rates in developing countries. Although rates of these disorders are lower in Mediterranean countries (eg, Greece, Italy, and Israel), and higher in northern and eastern Europe (eg, Russia and Scandinavia), they are responsible for a large proportion of the health-care burden in almost all populations.




The usual age of first drinking, independently of the family, is about 15 years and has not changed much in decades. This age does not differ much for those who go on to develop alcohol-use disorders and those who do not, although an earlier onset of regular drinking is associated with a greater likelihood of later problems. The period of heaviest drinking is usually between 18 and 22 years of age, and also does not differ much between those with future alcohol-use disorders and the general population. More than 60% of teenagers, even those without alcohol-use disorders, have experienced drunkenness by the age of 18 years, and about 30% have either given up events such as school or work to drink, or have driven while intoxicated. Alcohol abuse and dependence often begin in the early to mid-20s, at a time when most people begin to moderate their drinking as their responsibilities increase.




Repeated heavy drinking in alcohol-use disorders is associated with a 40% risk of temporary depressive episodes, and as many as 80% of alcohol-dependent people are regular smokers, a co-occurrence that could reflect either use of the second drug to deal with effects of the first or overlapping genetic predispositions.




Abstinence is the usual goal for treatment of dependence in the USA, although efforts to control drinking, or reduce harm, are more often deemed appropriate goals in the UK and other parts of Europe. Some studies have reported that about 20% of those with alcohol dependence were able to drink moderately without problems in the previous year, but this is often temporary, and other studies indicate that fewer than 10% ever develop long periods of non-problematic drinking.




About 40-60% of the risk of alcohol-use disorders is explained by genes and the rest through gene-environment associations. The environment includes the availability of alcohol, attitudes towards drinking and drunkenness, peer pressures, levels of stress and related coping strategies, models of drinking, and laws and regulatory frameworks.




The damage than can be caused by alcohol abuse and dependence is well documented, but includes effects on the cardiovascular system – due to increasing blood pressure and levels of ‘bad’ (HDL) cholesterol. Cancer is the second leading cause of early death in people with alcohol-use disorders, even after controlling for the effect of smoking. Almost 75% of patients who have head and neck cancers have alcohol-use disorders, and alcohol-use disorders also double the risk of cancers of the oesophagus, rectum, and breast. These findings could reflect alcohol-induced impairment of the immune system.




Dr Schuckit says: “Despite perceptions to the contrary, efforts to help
patients decrease heavy drinking commonly result in changes in behaviours, and most patients with alcohol-use disorders do well after treatment. About 50-60% of men and women with alcohol dependence abstain or show substantial improvements in functioning the year after treatment, and such outcomes are excellent predictors of their status at 3-5 years.”



He adds: “The intervention step effectively starts the process of recovery and can be delivered by the general physician. The process incorporates the principles of motivational interviewing, brief interventions, or both, to help a patient recognise their problem and take steps to minimise future difficulties. Interventions can be offered both to those who seek help and to patients with excessive drinking or alcohol-use disorders who are opportunistically identified… The goals of rehabilitation for alcohol-use disorders are the same as for any chronic relapsing disorder: to help to keep motivation high, change attitudes toward recovery, and diminish the risk of relapse. Cognitive-behavioural steps can help people to change how they think about alcohol and its role in their lives (the cognitive component); learn new behaviours for development and maintenance of abstinence or diminished drinking; and avoid relapses.” Furthermore, he discusses various drugs that are used for alcohol dependence, including naltrexone (in the USA).




He concludes: “The criteria for alcohol dependence are reliable, patients face substantial morbidity and mortality, and resources are available to identify patients with unhealthy drinking or alcohol-use disorders, and to offer treatment.




Treatment can include motivational interviewing to help people to evaluate their situations, brief interventions to facilitate more healthy behaviours, cognitive-behavioural therapies, and the judicious use of drugs to improve outcomes for alcohol-use disorders.”



“Alcohol-use disorders”


Marc A Schuckit

The Lancet. January 26th, 2009. DOI:10.1016/S0140-6736(09)60009-X




Source


Tony Kirby


Press Officer

The Lancet


32 Jamestown Road


Camden


London NW1 7BY

http://www.thelancet.com

[Via http://www.medicalnewstoday.com]

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