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Unformatted text preview: Seminar 492 www.thelancet.com Vol 373 February 7, 2009 Alcohol-use disorders Marc A Schuckit Alcohol dependence and alcohol abuse or harmful use cause substantial morbidity and mortality. Alcohol-use disorders are associated with depressive episodes, severe anxiety, insomnia, suicide, and abuse of other drugs. Continued heavy alcohol use also shortens the onset of heart disease, stroke, cancers, and liver cirrhosis, by aff ecting the cardiovascular, gastrointestinal, and immune systems. Heavy drinking can also cause mild anterograde amnesias, temporary cognitive defi cits, sleep problems, and peripheral neuropathy; cause gastrointestinal problems; decrease bone density and production of blood cells; and cause fetal alcohol syndrome. Alcohol-use disorders complicate assessment and treatment of other medical and psychiatric problems. Standard criteria for alcohol dependencethe more severe disordercan be used to reliably identify people for whom drinking causes major physiological consequences and persistent impairment of quality of life and ability to function. Clinicians should routinely screen for alcohol disorders, using clinical interviews, questionnaires, blood tests, or a combination of these methods. Causes include environmental factors and specifi c genes that aff ect the risk of alcohol-use disorders, including genes for enzymes that metabolise alcohol, such as alcohol dehydrogenase and aldehyde dehydrogenase; those associated with disinhibition; and those that confer a low sensitivity to alcohol. Treatment can include motivational interviewing to help people to evaluate their situations, brief interventions to facilitate more healthy behaviours, detoxifi cation to address withdrawal symptoms, cognitive-behavioural therapies to avoid relapses, and judicious use of drugs to diminish cravings or discourage relapses. Introduction The alcohol-use disorders consist of alcohol dependence, alcohol abuse, 1 and dependence or harmful use. 2 These are common and potentially lethal disorders that mimic and exacerbate a wide range of additional medical and psychiatric conditions, and thereby shorten the lifespans of aff ected people by more than a decade. 3 However, most people with alcohol-use disorders are hard to identity, since they are likely to have jobs and families, and present with general complaints such as malaise, insomnia, anxiety, sadness, or a range of medical problems. Both primary-care physicians and spets can help to screen for these disorders, institute brief interventions, and refer patients for more intensive care if needed. This paper presents a selective update of clinical developments regarding alcohol-use disorders that are relevant to practising physicians, and focus on skills that they already have or can easily acquire....
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This note was uploaded on 11/29/2010 for the course PSYCH SY BEH 102 taught by Professor Raymondw.novaco during the Spring '10 term at UC Irvine.
- Spring '10