Adelstein and colleagues (1984) found that cirrhosis mortality rates are higher than the national average for men from the Asian subcontinent and Ireland, but lower than average for men of African–Caribbean origin. Cirrhosis mortality was lower in Asian and African–Caribbean women but higher in Irish women. However, because there were few total deaths in ethnic minority groups this may lead to large errors in estimating prevalence in this population. Studies in England have tended to find over-representation of Indian-, Scottish- and Irish-born people and under-representation in those of African–Caribbean or Pakistani origin (Harrison & Luck, 1997). This may partly be due to differences in prevalence rates of alcohol misuse, but differences in culturally-related beliefs and help-seeking as well as availability of interpreters or treatment personnel from appropriate ethnic minority groups may also account for some of these differences (Drummond, 2009).
Teenagers with higher positive expectancies (for example, that drinking is pleasurable and desirable) are more likely to start drinking at an earlier age and to drink more heavily (Christiansen et al., 1989; Dunn & Goldman, 1998). This relationship remained after they adjusted for potential confounding factors such as substance use and depressive symptoms at age 16, suggesting that there may be a causal relationship between alcohol dependence and subsequent depression that is not explained by poor overall mental health in adolescence. Relapse represents a major challenge to treatment efforts for people suffering from alcohol dependence. To date, no therapeutic interventions can fully prevent relapse, sustain abstinence, or temper the amount of drinking when a “slip” occurs. For some people, loss of control over alcohol consumption can lead to alcohol dependence, rendering them more susceptible to relapse as well as more vulnerable to engaging in drinking behavior that often spirals out of control. Many of these people make numerous attempts to curtail their alcohol use, only to find themselves reverting to patterns of excessive consumption.
Are Some People More Prone to Alcoholism?
While the American Psychiatric Association used to separate alcohol abuse and alcohol dependence into two distinct disorders, both are now categorized into a single diagnosis called alcohol use disorder. An alcohol use disorder, which can range from problem drinking to alcoholism, can be classified as mild, moderate or severe, depending on a person’s symptoms and drinking behaviors. Older people are at least as likely as younger people to benefit from alcohol treatment (Curtis et al., 1989). Clinicians therefore need to be vigilant to identify and treat older people who misuse alcohol. As older people are more likely to have comorbid physical and mental health problems and be socially isolated, a lower threshold for admission for assisted alcohol withdrawal may be required (Dar, 2006).
A recent Scottish national alcohol needs-assessment using the same methods as ANARP found treatment access to be higher than in England, with one in 12 accessing treatment per annum. This level of access may have improved in England since 2004 based on the NATMS data. However, the National Audit Office (2008) reported that the spending on specialist alcohol services by Primary Care Trusts was not based on a clear understanding of the level of need in different parts of England. There is therefore some further progress needed to make alcohol treatment accessible throughout England. People who are alcohol dependent are often unable to take care of their health during drinking periods and are at high risk of developing a wide range of health problems because of their drinking (Rehm et al., 2003). Treatment staff therefore need to be able to identify and assess physical health consequences of alcohol use, and refer patients to appropriate medical services.
3.5. Public health impact
For example, women affected by economic loss showed increased alcohol consumption, whereas men showed increased intoxication, drinking consequences, and alcohol dependence (Mulia et al. 2014). Additional analyses of the same dataset determined that the association between exposure to severe economic loss and alcohol consumption and related consequences differed among Blacks, Hispanics, and Whites. For Hispanics, in contrast, only weak and ambiguous associations existed between economic loss and alcohol outcomes. Alcohol-related functional differences in the brain are not exclusively observed in dependent individuals. When comparing the neural response of light (consuming ~0.4 drinks per day) and heavy (consuming ~5 drinks per day) drinkers to alcohol cues, light drinkers have been found to have a higher BOLD signal in VS, while heavy drinkers show an increased BOLD signal in DS [102]. The DS response in the heavy drinkers suggests the initiation of a shift from experimental to compulsive alcohol use during which a shift in neural processing is thought to occur from VS to DS control [103].
However, such cross-sectional studies are unable to establish whether such differences are prodromal or consequential of alcohol exposure. A recent longitudinal study in adolescents showed that blunted BOLD response to non-drug reward was predictive of subsequent problematic alcohol use https://accountingcoaching.online/facing-your-powerlessness-in-addiction-recovery/ [104]. These results suggests that certain functional differences in reward processing may predate problematic alcohol consumption. Screening and brief intervention delivered by a non-specialist practitioner is a cost-effective approach for hazardous and harmful drinkers (NICE, 2010a).
Problematic Alcohol Abuse
There are several organisations available in England to provide mutual aid for service users and their families. Founded in the US in the 1930s, AA is based on a ‘12-step’ programme, and the ‘12 traditions’ of AA. The programme includes acceptance that one is powerless over alcohol, acceptance of the role of a higher power and the role of the support of other members. AA is self-financing and the seventh tradition is that AA groups should decline outside contributions.
- CRF acts on the pituitary gland located directly below the hypothalamus, where it initiates the production of a molecule called proopiomelanocortin (POMC).
- When a person begins to misuse alcohol, the gap between anticipated earnings and expenses and actual earnings and expenses can widen.
- Consideration of gender- and sex-related effects has also been limited, in part due to a lack of power [154].
- Treatment of alcohol withdrawal is, however, only the beginning of rehabilitation and, for many, a necessary precursor to a longer-term treatment process.
Although the standard drink amounts are helpful for following health guidelines, they may not reflect customary serving sizes. A large cup of beer, an overpoured glass of wine, or a single mixed drink could contain much more alcohol than a standard drink. Additionally, chronic drinkers may have to leave careers early due to health problems. If you drink regularly, alcohol changes the way your liver works, your brain function and creates dependence – meaning you need to drink more to have the same effect. If you find it very difficult to enjoy yourself or relax without having a drink, you could have become dependent on alcohol. Alcohol dependence is the need to drink alcohol often to function in your daily life.
In some cases, these analyses were limited to studies from only one country, whereas other analyses were cross-national. In any case, caution must be used when interpreting these findings, because the cultural and political contexts in which these phenomena occur can differ Understanding Powerlessness and Acceptance in Early Recovery widely. In addition, this article reviews some larger, population-based studies (see table 2), particularly those that were not addressed within the included reviews and which directly assess the association between SES and alcohol consumption and related outcomes.
The substantial variability in the course of co-occurring AUD and depressive disorders may reflect discrete underlying mechanisms, requiring distinct treatment approaches. For example, AUD that develops after the onset of a depressive disorder and is characterized by coping motives for alcohol use may differ critically from a depressive disorder that develops following chronic alcohol administration. Data from studies of depression indicate that the substantial variability in the symptoms presented reflects a heterogeneous pathophysiology,32 yet research on heterogeneity in co-occurring AUD and depressive disorders remains limited. Nevertheless, numerous pharmacotherapies have been employed to treat alcoholism, guided principally by advancing knowledge about alcohol’s interactions with various components of the brain’s reward and stress pathways (Heilig and Egli 2006; Litten et al. 2005; Spanagel and Kiefer 2008).
