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  » Alcoholism and treatment  »  Chronic Alcoholism

Although all those who drink alcohol are not addicts, repeated ingestion of alcohol can lead to addiction. In addicts, the normal feeling of well being depends on a continuous availability of the drug molecules in the body fluids and tissues, and there is such an intense craving that the desire to drink remains the only interest in life. Sudden withdrawal of alcohol for any reason may lead to withdrawal syndrome (Table 4.2).

Delirium tremens is rare (1%) but the most sever component of the abstinence syndrome which develops after sudden withdrawal of alcohol for some days in chronic alcoholics. The symptoms consist of restlessness, insomnia, tremors, hallucinations generally involving great fear, delirium and even convulsions. There is no specific treatment.
In addition the alcohol addict is liable to other neuropsychiatric syndromes such as Korsakoff's psychosis, hallucinosis, suicidal tendencies and Wernicke's encephalopathy. Apart from history and the obvious physical and mental degeneration, alcohol addiction can be diagnosed by demonstration of the drug in breath, blood or urine.
Generally, there are associated changes due to nutritional deficiencies such as polyneuritis due to thiamine deficiency; anemia and edema.
Chronic alcoholics may also suffer from hyperlipidemia, hyperuricemia, pancreatitis, hypomagnesemia and hepatic cirrhosis.
In case of alcohol dependence sudden and total withdrawal is usually effective because the withdrawal syndrome can be manages with drugs like benzodiazepines.

Table 4.2: Alcohol withdrawal syndromes

8 hours: Tremulousness, anxiety, irritability, nausea and vomiting (Tremulous syndrome).
24 hours: Hyperexcitability, insomnia, disordered perception and convulsions
(Seizure syndrome).
2-5 days: Tremor, hallucinations, disorientation and ANS overactivity
(Delirium tremens).

Treatment of chronic alcoholism:

Psychotherapy: Alcohol dependence is often reversible if treated during early stages, if the addict realizes that his drinking has become a problem to him. An addict is a sick person sometimes with a feeling of guilt. One way to overcome this guilt is to convince the addict that he is a sick person. Outright condemnation of his taking a drink would do more harm. Psychotherapy by a sympathetic doctor can often give rewarding results. Complete co-operation by the patient is very necessary and he should be explained that indulgence in even small quantities of alcohol again would lead to a relapse. Psychotherapy forms the mainstay of treatment, supported by drugs which are used to establish a conditioned reflex so that the addict becomes averse to alcohol.
Aversion therapy: Drug used for aversion therapy