Alcoholism has both medical and psychosocial factors. Ethanol, or primary
alcohol, is a central nervous system (CNS) depressant, which decreases neuronal
activity. Alcoholism, legally defined, is a concentration of at least 80 to 100
mg/dL. However, one to two drinks (i.e., 20 to 30 mg/dL) can cause psychomotor
and cognitive change. Death occurs at concentrations of 300 to 400 mg/dL. The
fourth edition of Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV) separates substance disorders into two categories: substance use
disorders (dependence, abuse) and substance-induced disorders (substance-induced
intoxication, withdrawal, psychotic, or mood disorders), and defines alcoholism
as lack of functioning such that
"the individual continues substance use despite significant substance-related problems."
Ninety percent of people drink alcohol at some time in their life. Alcoholism
affects 10% to 20% of men and 3% to 10% of women. Approximately 40% to 50% of
men have temporary alcohol-induced problems, with 30% to 40% experiencing
blackouts between their teens and late 20s. Alcoholism contributes to over 50%
of car and industrial fatalities, drownings, and child or domestic
Alcoholism is caused by chronic over-consumption of alcohol. Psychological
theories are not conclusive. Genetic predisposition has been shown.
Neurocognitive tests have predictive value. Environmental factors may influence
but do not cause alcoholism.
- Preexisting psychiatric disorder
- Early onset of alcohol consumption
|Signs and Symptoms|
Symptoms vary with the amount of alcohol ingested and duration of
- Adaptation to use
- Psychological, social, occupational dysfunction
- Malnutrition, anorexia
- Cardiovascular symptoms (leading cause of
death)—including hypertension, arrhythmias, paroxysmal
tachycardia ("holiday heart"), congestive heart failure; worsened with
- Increased levels of cancer (second leading cause of
death)—head, neck, esophagus, liver, pancreas, cardia
of the stomach, breast, lung, rectal
- Repeated infections—tuberculosis, urinary
- Pulmonary symptoms—complicated by smoking;
respiratory failure, pneumonia
- CNS—unsteady gait or stance; cognitive
impairment; psychiatric manifestations (e.g., mood, anxiety, psychotic
disorders); blackouts; coma; sleep latency
- Alcohol withdrawal syndrome—6 to 24 hours
after blood alcohol level drop; lasts two to seven days; ranges from nausea,
tachycardia, insomnia, and anxiety to fever, hallucinations, and rarely delirium
- Diarrhea, vomiting
- Gastrointestinal bleeding
- Men—increased sexual drive with concurrent
decreased erectile capacity
- Women—spontaneous abortion,
- Poor wound healing
- Swollen, painful muscles, paralysis, areflexia
- Increased bone fractures
Alcohol-induced organ damage and disease needs to be distinguished from
illnesses occurring without abuse.
Physical examination reveals specific organ damage (e.g, hepatomegaly,
indicating liver damage) or trauma. Muscles are tender or weak. Patient may or
may not appear intoxicated.
High-normal or elevated levels of the following are indicative of
- Blood alcohol
- Mean corpuscle volume
- Gamma-glutamyl transferase (GGT)
- Serum uric acid
- Carbohydrate-deficient transferin
- Creatine phosphokinase
- Serum AST and possibly ALT
- Serum bilirubin
- Folic acid deficiency causing hyperplastic bone marrow,
reticulocytopenia, hypersegmented neutrophils
- Decreased white blood cell production causing decreased response to
antigens; decreased granulocyte adherence and mobility; toxic
- Abnormalities in central adrenergic alpha- and beta-receptors and
- Nutritional deficiencies of potassium, magnesium, zinc, calcium,
phosphorous, folic acid, vitamins B1 (thiamine), B3
(niacin), B6 (pyridoxine), and vitamin A
- Hemorrhagic lesions of the duodenal villi
- Decreased water and electrolyte absorption
- Increased fatty accumulation in liver cells, cirrhosis
Imaging is used to diagnose alcohol-related diseases and to screen for
repeated bone fractures.
Alcoholism has a low diagnostic rate.
- Take history, consulting closest family member(s)
- Perform tests for alcohol-abuse markers and nutritional
- Screen for alcohol-related diseases
- Administer patient-completed tests (e.g., Michigan Alcohol Screening
- Determine need for
Treatment must include addressing both medical issues and rehabilitation.
Rehabilitation includes the following.
- Motivate abstinence
- Alcoholics Anonymous (or other support
- Administration of another type of CNS depressant for withdrawal
symptoms and seizure prevention
- Benzodiazepines—safest CNS depressants,
superior anticonvulsive; individualized dose depending on patient response, then
decrease by 20% each day for three to five days (e.g., chlordiazepoxide, 25 to
50 mg every four to six hours); choose benzodiazepines with shorter half-life
with liver or brain damage (e.g., lorazepam, 6 to 7 mg/day in three doses then
decrease to 1 to 2 mg/day)
- Antipsychotic medications—for those not
responding to benzodiazepines, no anticonvulsive properties (e.g., haloperidol,
240 mg/day; synergistic with lorazepam)
- Alcohol withdrawal syndrome—aggressive
control is essential (e.g., lorazepam, 0.5 to 4.0 mg every 10 to 30 minutes
intravenously); lumbar puncture and antibiotics for qualified seizure
|Complementary and Alternative
Psychosocial support and intervention is important. Therapists who have
specific experience with alcoholism should be recommended. Several nutrients are
deficient in alcoholism. Supplementation addresses deficiencies and may prevent
some alcohol-induced organ damage and decrease cravings. Herbs are useful to
facilitate proper liver functioning and provide symptom
The following nutrients are recommended.
- Vitamin A (25,000 IU/day)
- B-complex (B1 (50 to 100 mg/day), B2 (50
mg/day), B3 (25 mg/day), B5 (100 mg/day), B6
(50 to 100 mg/day), B12 (100 to 1,000 mcg/day)
- Vitamin C (1,000 mg bid to tid)
- Vitamin E (400 IU/day), cardioprotective
- Magnesium (250 mg bid) decreases withdrawal symptoms
- Selenium (200 mcg/day) protects against fatty liver
- Zinc (15 mg/day) deficiencies impair ethanol metabolism
- Chromium (250 to 500 mcg bid) helps reduce sugar cravings and helps
reduce hypoglycemic-related alcohol cravings
- Amino acids: carnitine (500 mg bid) is hepatoprotective, glutamine (1
g/day) decreases cravings, glutathione (300 mg/day) protects liver and
A well-balanced, nutritionally adequate diet helps to stabilize
alcohol-induced dysglycemia and to decrease cravings. Eliminate simple sugars,
increase complex carbohydrates, ensure adequate protein, increase essential
fatty acids, and decrease saturated fats and fried foods. Avoid caffeine as it
can induce hypoglycemia.
Herbs may be used as dried extracts (pills, capsules, or tablets), teas, or
tinctures (alcohol extraction, unless otherwise noted). Dose for teas is 1
heaping tsp. herb/cup water steeped for 10 minutes (roots need 20 minutes).
Herbal extracts made with alcohol should be avoided in
- Milk thistle (Silybum marianum): 80 to 200 mg tid is
hepatoprotective, treats alcohol-induced fatty liver and cirrhosis.
- Dandelion (Taraxacum officinale): 2 to 8 g of root tid as
decoction or infusion, or 5 ml tid of leaf tincture is a diuretic and liver
detoxifier. Works well with milk thistle.
- Kudzu (Pueraria lobata) reduces cravings.
- Skullcap (Scutellaria lateriflora): historic use for hysteria,
tension, and nervous disorders, especially anxiety; a cup of tea before bed can
- Dessicated liver capsules (500 mg tid) help heal liver
An experienced homeopath would consider an individual's constitutional type
to prescribe a more specific remedy and potency. Some of the most common acute
remedies are listed below. Acute dose is three to five pellets of 12X to 30C
every one to four hours until symptoms resolve.
- Arsenicum album for anxious, compulsive people, with nausea,
vomiting, and diarrhea
- Nux vomica for irritability and compulsiveness with
constipation, nausea, and vomiting
- Lachesis for cravings for alcohol, headaches, and difficulty
- Lycopodium for low self-esteem, heartburn,
May be very helpful at decreasing cravings and increasing recovery. It can
also be helpful for liver repair, reducing anxiety and depression, and
alleviating tremors and fatigue associated with alcohol withdrawal. Acupuncture
is helpful in maintaining sobriety.
After emergent care, follow-up should continue for 6 to 12
The best prevention is abstinence. With little evidence for efficacy,
disulfiram (250 mg/day) is often prescribed for prevention. Two promising
anticraving drugs are naltrexone and acamprosate.
- Wernicke-Korsakoff syndrome—symptoms may
occur together; Wernicke's encephalopathy (ataxia of gait, confusion, nystagmus,
ophthalmoplegia), usually acute and reversible; Korsakoff's (severe
amnesia—both anterograde and retrograde), reversible in
20% of patients
- Mallory-Weiss lesion—tear in the mucosa at
gastroesophageal junction from repeated, violent vomiting
- Irreversible testicular atrophy—loss of sperm
About a fifth of alcoholics permanently abstain. The course of illness
includes periods of remission followed by periods of abuse. Life expectancy is
decreased by about 15 years.
Abstinence from alcohol is the only completely safe measure during
- Ethanol rapidly transfers to the placenta, causing permanent fetal
damage, fetal death, and abortion
- Fetal alcohol syndrome may result in mental retardation, cardiac
defects, growth deficiencies, poor coordination, facial changes (e.g.,
epicanthic folds, flat-bridged
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Copyright © 2000 Integrative Medicine
CommunicationsThis publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
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The reader is advised to check product information (including package inserts)
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interactions, and contraindications before administering any drug, herb, or
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