Alcohol use disorder is a chronic brain diseaseㅣSource: Clip Art Korea
alcohol use disorder. This word, which may sound unfamiliar, is the official disease name for alcoholism. According to data released by the National Health Insurance Service, in 2018, 75,000 people were treated for alcohol use disorder. By gender, there are about 58,000 men and 17,000 women, about 3.4 times more male patients than female patients.
Regarding the reason why there are more male alcoholics, Professor Lee Deok-jong of the Department of Mental Health at Ilsan Hospital of the National Health Insurance Service speculated that biological factors may have an effect. “There are more male patients in common in most races and societies,” he said.
In addition to this, various social and cultural factors make the proportion of male patients higher. A culture that tolerates male drinking, environmental factors in which men are more likely to engage in social activities, and circumstances in which women abstain from drinking during pregnancy and childrearing are at work.
Although it affects fewer women, alcohol use disorder can affect women more severely. Women have fewer enzymes to break down alcohol than men. In addition, compared to body adipose tissue, the specific gravity of water that can dilute alcohol is small, so the amount of alcohol absorbed in the body is relatively increased compared to men. In other words, even if men and women drink the same amount, the toxicity of alcohol is higher in women, increasing the risk of liver disease and gastrointestinal disorders.
In 2018, the largest age group among all alcohol use disorder patients was in their 50s, accounting for 26.5% of the total. It was followed by 20.4% in their 40s and 18.7% in their 60s. Regarding this, Professor Lee Deok-jong said, “It is a time when various difficulties caused by excessive drinking are revealed on the surface, and patients in their 50s and 60s are experiencing serious health and social problems.” He explained, “Alcohol’s harmful effects on body and brain health gradually accumulate, but the body’s ability to resist gradually weakens. When this is combined, health problems become serious when the elderly and older people end up visiting the hospital.”
Dopamine secreted in the brainㅣSource: Getty Image Bank
Alcoholism is a brain disease, not a habit
Alcohol use disorder is a brain disease in which people who are genetically vulnerable to the use of addictive substances drink alcohol in response to stress and psychological stimulation, and the addiction circuit in the brain is strengthened as the drinking is repeated.
Alcohol entering the body stimulates the brain’s special central nervous system, the ‘compensation circuit (compensation system)’, and at this time, dopamine, a neurotransmitter that makes you feel pleasure, is secreted. However, if you drink alcohol repeatedly, the reward circuit is overstimulated and functional changes in the circuit occur. Because of this, drinking the same amount will not give you the same satisfaction you used to. In order to satisfy the pleasure, you need to consume more alcohol than before.
As this vicious cycle repeats, the control function of the compensation circuit is broken. The craving for alcohol intensifies, and if you can’t consume alcohol, you feel withdrawal. In addition, alcohol weakens the function of the frontal lobe, an area of the brain that allows for proper exercise of control and judgment. As alcoholism progresses, it becomes out of control.
Am I an alcoholic?…The diagnostic criteria are
The Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association presents the main symptoms of alcohol use disorder as follows: If two or more of the following 11 items apply, it is highly likely that you have alcohol use disorder.
1. Drinking alcohol often more than intended or over a long period of time
2. Attempts to reduce or control alcohol consumption but fail
3. Spending a lot of time in alcohol-related activities
4. Cravings for alcohol
5. Repeated drinking and failure to play a major role at work, etc.
6. Suffering from social or interpersonal problems due to drinking
7. Reduce important social and occupational activities and leisure because of drinking
8. Repeated drinking even when physically harmful
9. Continuing to drink despite knowing that alcohol is likely to cause or exacerbate physical or psychological problems.
10. Tolerance to alcohol
11. Withdrawal symptoms
Here, tolerance to alcohol means a case in which the amount of drinking must be greatly increased to obtain a desired effect by drinking alcohol, or the effect is significantly reduced when the same amount of alcohol is continuously consumed.
Alcohol withdrawal symptoms are complex physical and psychological symptoms that occur hours to days after abstinence or sobriety. Sweating or tachycardia, hand tremor, insomnia, nausea or vomiting, transient hallucinations, psychomotor agitation, and anxiety may occur. Occasionally, symptoms of delirium or seizures may appear.
Diagnosis is the first step in alcohol use disorder treatment.
Our brains become addicted, not in one instant, but over a long period of time. The more we drink, succumbing to any stress or craving, the stronger the alcoholism circuitry in our brain becomes, making us more vulnerable to alcohol.
If alcohol use disorder is not treated at the right time, brain function deteriorates and various organs in the body, such as the heart and liver, are damaged. In addition, cognitive and emotional distortions related to alcohol are gradually strengthened. For this reason, only when you visit a hospital in the early stages of alcohol use disorder and actively treat it is more likely to be cured and recovered.
If alcohol use disorder is diagnosed through an interview with a psychiatrist, blood tests and electrocardiograms are performed to determine if there are any physical abnormalities. If there are abnormal findings, consult with the related internal medicine for treatment. In addition, there are many cases in which EEG or brain imaging tests and neurological examinations are required. Because of the neurotoxicity of alcohol and systemic nutritional deficiency, gait abnormalities and hand tremor often occur, and withdrawal delirium or seizures occur in some cases. In particular, since structural atrophy of the brain often appears in elderly and elderly patients, brain imaging tests such as MRI are recommended.
How to treat alcoholism that can’t be overcome by willpower alone
Many people with alcohol use disorder are obsessed with the belief that they can stop drinking whenever they set their mind to it. Because of this false belief, rather than abstaining from drinking, we start with an attempt to gradually reduce alcohol. However, abstinence, not sobriety, can cure alcohol use disorder. This is because it is necessary to maintain sobriety for several months to weaken the addiction circuit that is strengthened in the brain and stabilize brain function.
Severe withdrawal symptoms appear about 6 hours after the patient starts to stop drinking. Increased anxiety, insomnia, rapid pulse and hallucinations. When withdrawal symptoms appear, drug treatment is administered to help restore the balance of brain activity. The drugs used at this time are benzodiazepines, such as tranquilizers.
In addition, in order to recover the body and brain damaged by alcohol, infusion treatment with high-concentration vitamins is included. This is because many patients who only drink alcohol and do not eat a balanced diet are often deficient in essential nutrients. Alcohol, which enters the body in a situation where nutrient intake is insufficient, inhibits the absorption of vitamin B1. Because of this, many patients suffer from essential nutrient deficiencies, such as vitamin B1 deficiency.
After this detoxification process, drugs to reduce the craving for alcohol are administered to maintain sobriety. Typical anti-craving drugs are Acamprosate and Naltrexone. Acamprosate acts to reduce the craving for alcohol by acting on receptors in the brain that are closely related to alcohol dependence. Naltrexone also reduces alcohol intake by reducing the craving for alcohol and reducing the pleasure that occurs when drinking alcohol.
In addition, through counseling and cognitive behavioral therapy, cognitive distortions are corrected and emotional stress factors are alleviated. Medical staff help patients find and create a way of life that is not dependent on alcohol.
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