ALCOHOL DEPENDENCE AND HARMFUL ALCOHOL USE Alcohol-Use Disorders NCBI Bookshelf

The UK Cabinet Office recently estimated that the cost of alcohol to society was £25.1 billion per annum (Department of Health, 2007). A recent report by the Department of Health estimated an annual cost of £2.7 billion attributable to alcohol harm to the NHS in England (Department of Health, 2008a). Hospital inpatient and day visits accounted for 44% of these total costs, whilst accident and emergency department visits and ambulance services accounted for 38%. However, crime physiological dependence on alcohol and disorder costs amount to £7.3 billion per annum, including costs for policing, drink driving, courts and the criminal justice system, and costs to services both in anticipation and in dealing with the consequences of alcohol-related crime (Prime Minister’s Strategy Unit, 2003). The estimated costs in the workplace amount to some £6.4 billion through lost productivity, absenteeism, alcohol-related sickness and premature deaths (Prime Minister’s Strategy Unit, 2003).

The Cycle of Alcohol Addiction

The remaining variation is accounted for by environmental factors and their interaction with genetic factors. While no single gene for alcohol dependence has so far been identified, a range of genes that determine brain function have been implicated (Agrawal et al., 2008). Degradation of brain structure appears to underlie alcoholism-related alterations in the selection of cognitive strategies to execute a task, and the new neural pathways taken can be identified with fMRI. These analyses found that a change in processing strategy occurs, where alcoholics use inefficient neural systems to complete a task at hand because the preferred neural nodes or connecting fiber tracks are compromised. Such compensatory activation may be crucial for adequately completing a task but curtails available capacity to carry out multiple activities in parallel.

Alcohol withdrawal management SA Health

Additionally, compounds that target a specific component of the GABAA receptor complex (i.e., the α1-subunit)3 suppress alcohol drinking when they are injected into the ventral pallidum, an important region that receives signals from neurons located in the extended amygdala (Harvey et al. 2002; June et al. 2003). In terms of services provided by community specialist agencies, the majority (63%) provide structured psychological interventions either on an individual basis or as part of a structured community programme (Drummond et al., 2005). There is considerable variation in the availability and access to specialist alcohol services both in community settings and in inpatient settings where provision of specialist psychiatric liaison services with responsibility for alcohol misuse is also very variable. Only 30% provide some form of assisted alcohol-withdrawal programme, and less than 20% provide medications for relapse prevention.

How Does Addiction Develop in the Brain?

Topiramate is another FDA-approved drug used in the treatment of seizure disorder that is also effective in preventing migraines and facilitating weight loss (when used in combination with phentermine). Topiramate was shown to result in a greater number of abstinent days and lower binge drinking frequencies when compared to placebo treatment [280]. Topiramate seems to have a greater effect when compared to naltrexone and acamprosate, which are more commonly prescribed in AUD [280]. Further research is needed to clarify the context in which treatment with topiramate will be most beneficial. Acute and chronic alcohol exposure has also been shown to affect synaptic plasticity, therefore influencing the efficacy of synaptic transmission at synapses.

Sugar levels

As a result, these neurons release dopamine in the nucleus accumbens, activating reward processes there. Similarly, alcohol may inhibit release of the excitatory neurotransmitter glutamate from nerve terminals that act on neurons in the nucleus accumbens. Many additional mechanisms (not shown) are proposed, through which alcohol may act on these pathways.

• Nevertheless, emerging evidence shows a role for lipids in the regulation of many ion channels, and there still is interest in the possibility that alcohol can alter these lipid– protein interactions and thus alter protein function (Yuan et al. 2008).
• Alcohol is implicated in a high proportion of cases of child neglect and abuse, and heavy drinking was identified as a factor in 50% of child protection cases (Orford et al., 2005).
• However, when global and local information are contradictory, alcoholics find it difficult to disengage from one level of processing to the other.
• If you suspect you may have become physically dependent on a prescription medication that your healthcare provider has asked you to take, contact the physician who prescribed the medication to you.
• A greater understanding of this process is emerging following the identification, for example, of altered myelin repair gene expression in the frontal cortex of alcoholics (Liu et al. 2006).
• There is a high prevalence of alcohol misuse (as well as mental and physical health, and social problems) amongst people who are homeless.

Alcohol Use Disorder: Neurobiology and Therapeutics

In alcohol binge-drinking rats, however, both the proliferation of neural stem cells and the survival of neurons produced from the stem cells during alcohol exposure are decreased (Nixon and Crews 2002). The prefrontal cortex and, particularly, the orbitofrontal cortex7 have central roles in executive functions, such as decisionmaking. Accordingly, deficits in these brain areas may impact motivational circuits, impairing the ability of the organism to inhibit impulsive behavior and thereby further contributing to pathological drug-seeking behavior (Jentsch and Taylor 1999). More recently, imaging techniques were used to show that alcohol-dependent humans have smaller amygdala volumes than nondependent individuals and that smaller amygdala volume in alcohol-dependent humans is predictive of subsequent alcohol relapse (Wrase et al. 2008).

• Many people assume the occasional beer or glass of wine at mealtimes or special occasions doesn’t pose much cause for concern.
• At-Risk Stage – Known as the pre-alcoholic stage, this is when you choose to drink socially or at home.
• There is therefore some further progress needed to make alcohol treatment accessible throughout England.
• However, a proportion of people with psychiatric comorbidity, usually those in whom the mental disorder preceded alcohol dependence, will require psychosocial or pharmacological interventions specifically for the comorbidity following assisted withdrawal.

The endogenous opioid system has important implications for addiction, including modulation of DA release in the NA and of DAergic neurotransmission within the mesolimbic pathway [120]. Polymorphisms of the Oprm1 gene, which encodes the µ-opioid receptor, have been studied in relation to alcohol addiction with mixed results [121,122,123,124,125,126]. Additionally, both the delta and kappa opioid receptors have also been implicated in alcohol addiction [127,128]. Indeed, single nucleotide polymorphisms of Orpk1 and Orpd1 genes may influence behavioural responses to naltrexone [127]. Given this background and so as to effectively treat AUD, it is imperative that we understand the neurobiological mechanisms behind the development of addiction.

As noted above, many people will recover from alcohol-use disorders without specialist treatment and many will reduce their alcohol intake following a change in circumstances, such as parenthood, marriage or taking on a responsible job. Hazardous and harmful drinkers may respond to a brief intervention provided in primary care without requiring access to specialist treatment (NICE, 2010a). For others, their alcohol problems are overcome with the help of a mutual aid organisation, such as Alcoholics Anonymous (AA; see Section 2.10).

Understanding Alcohol Use Disorder

This is measured on a scale of severity ranging from mild to severe, depending on the number of diagnostic criteria met by the patient. There are many factors that influence a person’s susceptibility to alcohol addiction, including age at the onset of consumption, genetic predispositions including family history of AUD, as well as stress and other environmental and socioeconomic factors. Glutamate is the major excitatory neurotransmitter in the brain; it exerts its effects via several receptor subtypes, including one called the N-methyl-d-aspartate (NMDA) receptor. Glutamate systems have long been implicated in the acute reinforcing actions of alcohol, and alcohol effects perceived by an organism can be mimicked with NMDA receptor antagonists (Colombo and Grant 1992). In contrast to its effects on GABA, alcohol inhibits glutamate activity in the brain. For example, acute alcohol exposure reduces extracellular glutamate levels in a brain region called the striatum, which contains the nucleus accumbens, among other structures (Carboni et al. 1993).