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ALCOHOL USE DISORDER

2022-12-20 07:45:48
Alcohol use disorder is a pattern of alcohol use that involves problems controlling your drinking, being preoccupied with alcohol or continuing to use alcohol even when it causes problems. It involves heavy or frequent alcohol drinking even when it causes problems, emotional distress or physical harm.
As per World Health Organization One fourth to One third of male population drinks alcohol in India. Alcohol use is quite common in India both in rural and urban areas with prevalence rates as per various studies varying from 23% to 74% in males in general and although its not that common in females but it has been found to be prevalent at the rate 24% to 48 % in females in certain sections and communities. In 2005 the estimated numbers of people using alcohol in India was 62.5 million with 17.4 % of them (10.6 million) having alcohol use disorder and of all hospital admissions in India 20-30% are due to alcohol related problems.
Alcohol Use Disorder is the continuous use of alcohol despite evidence of harm and repeated attempts to cut down the use. It includes tolerance to alcohol which means higher amount is needed progressively to have the same effect and a characteristic cluster of mental and behavioural symptoms appearing when one does not take alcohol i.e., withdrawal.
What causes alcoholism?
Genetic factors, environmental factors, and the interplay of genetics and the environment have all been implicated in the aetiology of alcoholism. Several of the most common causes of alcoholism are: biological factors, environmental factors, social factors and psychological factors. Growing up around family members and close relatives that suffer from alcoholism increases the risk of alcohol abuse for generations to come. When you are surrounded by people who drink, Drinking in an effort to reduce stress can quickly turn problematic, When a partner or close friend frequently drinks, you may be more inclined to join them. Giving into peer pressure can lead to drinking problems down the road, as well as many health complications that arise from excessive alcohol consumption, When drinking too much becomes a pattern, you greatly increase your chances of developing an alcohol-related problem. The more you drink, the more your body builds a tolerance to alcohol. Tolerance means you will need more alcohol to feel the same affects you used to feel with less.
DSM-5 diagnosis of AUD (Alcohol Use Disorder) requires at least two symptoms out of 11, which can be combined in various ways over the course of a year.

1. Consumes more alcohol or spends more time drinking than intended.
2. Wants to limit or halt alcohol use, but hasnt succeeded.
3. Spends a significant amount of time obtaining alcohol, drinking alcohol, and recovering from alcohol consumption.
4. Craves alcohol.
5. Has suffered consequences at home, school, or work due to recurring alcohol use.
6. Has suffered relationship problems due to recurring alcohol use.
7. Has given up or cut back on enjoyable activities due to recurring alcohol use.
8. Continues to use alcohol in situations when its physically dangerous (e.g., drives drunk, has unprotected sex).
9. Continues to use alcohol despite knowing its causing them physical or psychological harm.
10. Has become increasingly tolerant of alcohol, meaning they are less sensitive to the effects of drinking and need to drink more to become intoxicated.
11. Suffers withdrawal symptoms within a few hours or days after they stop drinking.


The DSM-5 also breaks down AUD by severity:

  1.  Mild AUD: has 2-3 symptoms
  2.  Moderate AUD: has 4-5 symptoms
  3.  Severe AUD: has 6+ symptoms

According to the ICD 10, a definite diagnosis is made when three or more of the key features of dependence have been present at the same time during the previous year:

  1.  A strong desire or sense of compulsion to drink alcohol
  2.  Difficulties in controlling drinking behaviour in terms of its onset, termination, or levels of consumption;
  3. A physiological withdrawal state when drinking has stopped or been reduced, as evidenced by the characteristic alcohol withdrawal syndrome (tremor, sweating, anxiety, nausea and vomiting, agitation, insomnia) or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms;
  4. Evidence of tolerance, such that increased quantities of alcohol are required to achieve the effects originally produced by lesser amounts;
  5. Progressive neglect of alternative pleasures or interests because of alcohol consumption, increased amount of time necessary to obtain or drink alcohol or to recover from its effects;
  6. Persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states consequent to period of heavy substance use , or drug related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the natural and extent of the harm.

Treatment for alcohol use disorder can vary, depending on your needs. Treatment may involve a brief intervention, individual or group counselling/Therapy , an outpatient program, or a residential inpatient stay.

Motivational Interviewing

MI helps people to explore and resolve their ambivalence about their substance use and begin to make positive behavioural and psychological changes. The principles of MI include expressing empathy through reflective listening, developing discrepancy between patients goals or values and their current behaviours, avoiding argument and direct confrontation, adjusting to client resistance and supporting self-efficacy and optimism.

Motivational Enhancement Theory

MET is a therapy designed to quickly produce internally motivated change (Miller, 1992). Based on motivational psychology, MET uses a combination of assessments, goal setting, and motivational interviewing to move a client from ambivalence about their recovery to a mind set of change. MET comprises four carefully planned treatment sessions. Prior to treatment, the client completes a battery of assessments lasting 7 to 8 hours. The entire purpose of MET is to move the client into a motivated state for change. After they have reached this state, the therapist and client can then work together to create a plan. The trans theoretical model of the stages of change is incorporated into the MET process. These stages can be a good framework for envisioning the process of addiction recovery.

There are six stages of change, according to the model created by DiClemente and Prochaska (1998):

1. Pre-contemplation

2. Contemplation

3. Determination

4. Action

5. Maintenance

6. Relapse

In MET, the therapists meet the client in whichever stage they are in, and the goal is to assist them in moving through each of these stages. According to this model, the contemplation and determination stages are the most critical (Miller, 1992). When approaching someone with AUD or a drinking problem, it is important to do research and approach them calmly at an appropriate time and place. If this conversation does not work, it may be necessary to stage an intervention with the support of a professional or others. If someone is helping a person with AUD, they must be mindful not to enable drinking behaviour. During AUD recovery, a person should focus on taking care of themselves and engaging in positive self-care behaviours.


Author:


Seerat Praveen Sharma, M.Phil. 1st year trainee

(Clinical Psychology, RCI) at CIIMHANS, under the supervision of Dr. Ranjita (Assistant Professor of Clinical Psychology) at CIIMHANS, Chhattisgarh.