We are keen to make sure we are asking the right questions and looking for the right answers which will be useful for people in all areas of services. We are engaging with both users and providers of alcohol and substance use services throughout the project to keep us focused on working towards practical and meaningful findings.
Drug and Alcohol Review
Alcohol use disorders AUDs and substance use disorders SUDs have significant avoidable global human and economic cost. Pharmacological interventions inherently have complications, and alternative therapies for treatment and prevention are needed. To systematically review the evidence to date in order to describe and quantify the effects of PA on AUDs and SUDs and understand how it is best delivered or promoted, in what setting, and among which populations, to encourage the prevention, reduction, and abstinence from AUDs and SUDs.
In the final phase of the study our aim is to elicit the views of service leads and users on how the findings can be used to guide future funding and interventions for reducing progression, use and post-treatment relapse. A wide selection of electronic databases will be searched based on a list of key words to generate a list of published research including grey literature and qualitative investigations which will then be screened independently by two researchers according to a predefined checklist.
Data across similar studies will be synthesised in a meta-analysis. Moreover, we will provide a detailed narrative synthesis using tables, diagrams and narrative texts across the studies, interventions, outcomes, populations and settings. After summarising this literature service, leads and users will have the chance to reflect on and add further guidance on how PA interventions can be designed to have greatest reach and effectiveness. They will also add to recommendations on how support for PA can be offered within the NHS, and other public health services, and appropriate third sector and charity organisations, with implications for funding.
Alcohol Abuse, Alcoholism and Alcohol Dependence?
The review will examine the many aspects of PA in how it is delivered, to whom, by whom, and in what setting to present the potentially most effective services. It will provide information for those involved in the treatment and prevention of AUDs and SUDs as to the most effective and cost-effective applications of PA.
It will also highlight potential research gaps to allow for future research planning within the NHS. The review will also be presented to the appropriate NICE Guidelines review panel with ideas on how the findings could be incorporated into future revisions of guidance on effective interventions.
Should there be a need for further research on the effectiveness and cost-effectiveness of PA interventions for specific groups then we will present the findings to the appropriate NIHR prioritisation panel, and other funders e. Aims To systematically review the evidence to date in order to describe and quantify the effects of PA on AUDs and SUDs and understand how it is best delivered or promoted, in what setting, and among which populations, to encourage the prevention, reduction, and abstinence from AUDs and SUDs.
In the DSM-IV , alcohol abuse and alcohol dependence were defined as distinct disorders from to The DSM-5 combined those two disorders into alcohol use disorder with sub-classifications of severity. There is no " alcoholism " diagnosis in medical care. Alcohol misuse is a term used by United States Preventive Services Task Force to describe a spectrum of drinking behaviors that encompass risky drinking, alcohol abuse, and alcohol dependence similar meaning to alcohol use disorder but not a term used in DSM.
Individuals with an alcohol use disorder will often complain of difficulty with interpersonal relationships, problems at work or school, and legal problems.
Additionally, people may complain of irritability and insomnia. However, while these findings are often present, they are not necessary to make a diagnosis of alcohol abuse. Signs of alcohol abuse show its drastic effects on the central nervous system, including inebriation and poor judgment; chronic anxiety, irritability, and insomnia. Alcohol's effects on the liver include elevated liver function tests classically AST is at least twice as high as ALT. Prolonged use leads to cirrhosis and liver failure. With cirrhosis, patients develop an inability to process hormones and toxins.
The derangements of the endocrine system lead to the enlargement of the male breasts.
Physician's Guide to Helping Patients with Alcohol Problems
The inability to process toxins leads to liver disease, such as hepatic encephalopathy. Alcohol abuse can result in brain damage which causes impairments in executive functioning such as impairments to working memory, visuospatial skills, and can cause an abnormal personality as well as affective disorders to develop. Alcohol also causes impairment in a person's critical thinking. A person's ability to reason in stressful situations is compromised, and they seem very inattentive to what is going on around them. The prefrontal cortex is responsible for cognitive functions such as working memory , impulse control and decision making.
This region of the brain is vulnerable to chronic alcohol-induced oxidative DNA damage. A smaller volume of consumed alcohol has a greater impact on the older adult than it does on a younger individual. As a result, the American Geriatrics Society recommends for an older adult with no known risk factors less than one drink a day or fewer than two drinks per occasion regardless of gender.
Alcohol abuse is significantly associated with suicide and violence. Alcohol is the most significant health concern in Native American communities because of very high rates of alcohol dependence and abuse; up to 80 percent of suicides and 60 percent of violent acts are a result of alcohol abuse in Native American communities.
In the United States alcohol-related violence is related to more severe injuries and chronic cases. Alcohol abuse among pregnant women causes their baby to develop fetal alcohol syndrome. Fetal alcohol syndrome is the pattern of physical abnormalities and the impairment of mental development which is seen with increasing frequency among children with alcoholic mothers.
Surviving infants may suffer severe abnormalities such as abnormal eyes, fissures, lips and incomplete cerebella. Some infants may develop lung disease. It is even possible that the baby throughout pregnancy will develop heart defects such as ventricular septal defect or atrial septal defect. However, other organizations advise complete abstinence from alcohol while pregnant.
Adolescence and the onset of puberty have both a physiological and social impact on a developing person. About half of grade 12 students have been drunk, and a third binge drink. Its symptoms include troublesome behaviour in school, constantly lying, learning disabilities and social impairments.
Alcohol: Balancing Risks and Benefits
Alcohol abuse during adolescence greatly increases the risk of developing an alcohol use disorder in adulthood due to changes to neurocircuitry that alcohol abuse causes in the vulnerable adolescent brain. Societal inequalities among other factors have influenced an adolescents decision to consume alcohol. Bogren, . The cause of alcohol abuse is complex.
Alcohol abuse is related to economic and biological origins and is associated with adverse health consequences.
Another influencing factor among adolescents and college students are the perceptions of social norms for drinking; people will often drink more to keep up with their peers, as they believe their peers drink more than they actually do. They might also expect to drink more given the context e. Alcohol abuse is also associated with acculturation, because social and cultural factors such as an ethnic group's norms and attitudes can influence alcohol abuse.
A person misusing alcohol may be doing so because they find alcohol's effects provide relief from a psychological problem, such as anxiety or depression.
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Often both the alcohol misuse and psychological problems need to be treated at the same time. The numbing effects of alcohol and narcotics can become a coping strategy for traumatized people who are unable to dissociate themselves from the trauma. However, the altered or intoxicated state of the abuser prevents the full consciousness necessary for healing. Gender differences may affect drinking patterns and the risk for developing alcohol use disorders. Excessive alcohol use causes neuroinflammation and leads to myelin disruptions and white matter loss.
The developing adolescent brain is at increased risk of brain damage and other long-lasting alterations to the brain. Until recently, the underlying mechanisms mediating the link between pubertal maturation and increased alcohol use in adolescence was poorly understood. Now research has suggested that sex steroid hormone levels may play a role in this interaction. When controlling for age, it was demonstrated that elevated estradiol and testosterone levels in male teenagers undergoing pubertal development was linked to increased alcohol consumption. The same associations with hormone levels were not demonstrated in females undergoing pubertal development.
It is hypothesized that sex steroid hormones, such as testosterone and estradiol, are stimulating areas in the male brain that function to promote sensation-seeking and status-seeking behaviors and result in increased alcohol usage. Additionally, the enzyme TTTan aromatase, which functions in the male brain to convert testosterone to estradiols, has been linked to addictive and reward-seeking behaviors.
Therefore, the increased activity of the enzyme may be influencing male adolescent alcohol-usage behaviors during pubertal development. The brain goes through dynamic changes during adolescence as a result of advancing pubertal maturation, and alcohol can damage long- and short-term growth processes in teenagers. For its diagnosis, at least one of the following criteria had to be fulfilled in the last 12 months:. The alcohol abuse diagnosis is no longer used in the DSM-5 released in , it is now part of the alcohol use disorder diagnosis.
Of the four alcohol abuse criteria, all except the one referring to alcohol-related legal problems are included in the alcohol use disorder criteria. Preventing or reducing the harm has been called for via increased taxation of alcohol, stricter regulation of alcohol advertising and the provision of brief Interventions. Brief Interventions for alcohol abuse reduce the incidence of unsafe sex, sexual violence, unplanned pregnancy and, likely, STD transmission. According to European law, individuals who are suffering from alcohol abuse or other related problems cannot be given a license, or if in possession of a license cannot get it renewed.
Related Alcohol Problems: Reviews, Research and Recommendations
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