Alcoholism Testing- General Medicine/ Check Up

Alcohol use disorder (AUD), colloquially known as alcoholism, is a medical condition marked by an impaired ability to reduce or control alcohol consumption in the face of negative social, professional, or health consequences. The terms "alcohol abuse," "alcohol dependence," and "addiction" are all used to describe conditions that are included in this category.

Heavy or frequent binge drinkers are more prone to suffer from alcohol use disorder. Having more than four drinks per day or more than 14 in a week is considered heavy drinking for men. When women consume more than three drinks a day or more than seven in a week, they are deemed heavy drinkers.

Yet, there is no specific number of drinks per day or week that will automatically diagnose you with the disease. The impact on your life from alcohol will affect the diagnosis.

The severity of AUD, which is classified as a neurological condition, can range from mild to severe. Alcohol misuse causes long-lasting changes in the brain that perpetuate AUD and make people susceptible to relapse.

Symptoms Of Alcoholism

People frequently deny that they abuse alcohol. Also, you might not be aware of your own or another person's alcohol use disorder.

There is a list of 11 symptoms of alcohol consumption disorders in the "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition" (DSM-5), which was published in 2013. Your need for help is more urgent the more symptoms you have.

There are three levels of severity for alcohol use disorders: mild, moderate, and severe.

• Mild: You might be labeled with a mild condition if you exhibit two to three of the 11 symptoms on the list.
• Moderate: You probably have a moderate alcohol consumption disorder if you have four to five symptoms.
• Severe: You have a severe alcohol use disorder if you exhibit six or more of the symptoms.

Below are the associated symptoms:

1. Alcohol is frequently used in greater quantities or for more extended periods of time than intended.
2. There are unsuccessful attempts or a persistent desire to reduce or regulate alcohol consumption.
3. Activities required to obtain alcohol, consume alcohol, or recover from its effects take up a significant amount of time.
4. Having a strong urge, craving, or desire to drink alcohol.
5. Chronic alcohol use that prevents you from performing essential duties at school, work, or home.
6. Persistent or frequent alcohol use despite social or interpersonal issues brought on by or worsened by the effects of alcohol.
7.  Alcohol use causes important social, professional, or recreational activities to be reduced or abandoned.
8. Alcohol consumption on a regular basis in dangerous physical settings.
9. Despite being aware of having a persistent or recurring bodily or psychological issue that alcohol is likely to have contributed to or made worse, alcohol usage persists.
10. Tolerance, which means a requirement for significantly higher doses of alcohol to produce the intended intoxication or effect or by a considerably reduced effect with continuing usage of the same amount of alcohol.
11. Alcohol (or a drug closely related to it, like a benzodiazepine) is used to treat or prevent the withdrawal symptoms typically associated with alcohol use.

To evaluate symptoms, a healthcare professional may ask the following questions.

In the last year:

• Have there ever been instances where you drank more or for longer than you planned?
• More than once, tried to reduce or stop drinking but was unsuccessful?
• Have you spent considerable amounts of time drinking? Or from being sick or recovering from other side effects?
• Have you ever wanted a drink so desperately that nothing else came to mind?
• Have you noticed that taking care of your home or family was frequently hampered by drinking or becoming sick due to drinking? Or created issues at work or school?
• Have you stayed drunk despite it upsetting your relationships with your family or friends?
• Given up or reduced participation in intriguing, meaningful, or enjoyable pursuits to drink?
• Have you ever engaged in activities (such as swimming, driving, using machinery, engaging in unprotected sex, or wandering in unsafe areas) while intoxicated or afterward?
• Drank despite feeling unhappy, worried, or that it was aggravating another health issue? Or after experiencing a memory blackout?
• Had to drink a lot more than you did previously to get the desired effect? Or did you discover that your regular quantity of drinks had far less of an impact than before?
• Have you ever experienced withdrawal symptoms such as difficulty sleeping, trembling, sweating, nausea, restlessness, a racing heart, or a seizure as the effects of alcohol started to wear off? or noticed something that was not there?

Any of these signs or symptoms could be alarming. More the number of symptoms, the greater the need for seeking treatment.

What Increases The Risk For Alcoholism?

The quantity, frequency, and rate of alcohol consumption affect a person's chance of developing AUD. Over time, alcohol abuse, which includes binge drinking and excessive drinking, raises the risk of AUD.

Combinations of genetic, psychological, environmental, and social factors—many of which are still being studied—can lead to an alcohol consumption problem. The most common risk factors are as follows:

Chronic, heavy drinking. Alcohol cravings can result from heavy and long-term drinking because excessive alcohol use has been shown to change the brain regions in charge of judgment, pleasure, and self-control.

Family history. Compared to the general population, children of alcoholic parents are two to six times more likely to acquire an AUD. This higher risk is probably caused by genetics (heritability is roughly 60%) as well as environmental and lifestyle factors that are shared by family members. The drinking habits of the parents may also influence the risk that a kid may eventually develop alcoholism.

History of trauma. Childhood trauma, emotional abuse, physical abuse, physical neglect, and emotional neglect, has been connected to an increased risk of developing AUD as an adult.

Psychiatric conditions. Studies have shown that alcohol and other drug abuse is more common among those with mental health disorders such as depression, anxiety, schizophrenia, post-traumatic stress disorder, bipolar disorder, and attention deficit hyperactivity disorder. In fact, research indicates that nearly one-third of schizophrenia patients fit the bill for an AUD diagnosis.

Cultural and social factors. If a person is exposed to heavy drinking at an early age, drinking parents, friends, spouses, and other role models may increase their likelihood of developing alcoholism.

Nutrition. Another significant factor that affects the risk that alcohol has on the body is nutrition. Many factors can affect how alcohol and nutrition interact. Heavy drinking can affect how well you eat, and nutrition-alcohol interactions can affect how your genes express themselves.

How Do Healthcare Providers Test For Alcoholism?

Healthcare professionals utilize one of three techniques to assess your alcohol consumption:

• Traditional brief screening
• The measurement of blood alcohol concentration (BAC)
• The carbohydrate-deficient transferrin test (CDT)

Because its accuracy depends entirely on the patient providing accurate and honest information about how much they consume, the traditional brief screening is less trustworthy than the other two techniques. The CDT test analyzes biomarkers to identify a recent history of dangerous amounts of alcohol intake, whereas the BAC test examines the amount of alcohol currently in the bloodstream.

The CDT test is a better predictor of binge or daily heavy drinking (four or more drinks per day) compared to the other two tests. It can even be used to assess whether an alcoholic has relapsed.

CDT Blood Test

As its name implies, the CDT blood test measures the amount of CDT in the blood. Iron is transported to the liver, bone marrow, and spleen by a protein known as carbohydrate-deficient transferrin. When someone drinks a lot of alcohol, the level of CDT in the body rises to the point where it may be detected in a blood sample. As a result, this increase is a biomarker of excessive drinking.

Compared to excessive drinking, low or moderate alcohol consumption is linked to decreased CDT blood levels. The cutoff for several CDT tests is less than 1.7%. For the two weeks preceding the test, those who consume four or more drinks per day, at least five days per week, have significantly higher CDT levels.

The CDT test has a very high sensitivity for identifying heavy drinking. The test reveals significant alcohol intake over an extended time, much like an A1C test (that measures blood glucose levels over the previous 90 days). After two to four weeks of abstinence, CDT levels return to normal. Likewise, after a few days, if they start drinking again, the levels rise once more.

DSM-5 Criteria

Individuals must meet two of the 11 criteria for AUD listed in the DSM-5 throughout the same 12-month period to be diagnosed with alcoholism. The above criteria are quickly summarized as follows:

• Attempting to stop but failing.
• Drinking more than you intended.
• Drinking-related absences from work or school.
• Increased alcohol-seeking behavior.
• Craving for a drink.
• Interference with important activities.
• Drinking despite issues at home or in society.
• Alcohol use persists despite health issues.
• Drinking even when there is danger.
• Increase in tolerance.
• Withdrawals when trying to stop.

Other Tests

The following tests can also be used to determine how much alcohol you consume.

1. Alcohol use disorders identification test: A common screening test that might help decide whether you need to change your drinking habits.
2. Alcohol use disorders identification test consumption: A more straightforward exam to determine whether your drinking has reached harmful levels.

Treatment

The good news is that treatment, which frequently combines medication, behavioral therapy, and support, can help most people with AUD. But unfortunately, less than 10% of people actually receive therapy, sadly as a result of stigma or shame, denial of the problem or lack of understanding of it, skepticism towards treatment, and difficulty accessing affordable care.

An excellent place to start is by speaking with your primary care physician, who can evaluate your general health, assess how much you drink, and assist you in creating a treatment plan. He may refer you to a treatment center or an addiction specialist and determine whether you require any medications for alcohol.

Detox And Withdrawal

You could require a medical detox to help manage the symptoms of alcohol withdrawal, which can range from moderate to severe, depending on the severity of your AUD.

Detox can be performed in person or on an outpatient basis, using intravenous (IV) fluids to prevent dehydration and drugs for treating seizures or other problems of alcohol withdrawal.

Behavioral Treatment

Working with a qualified expert to comprehend your relationship with alcohol and to understand how to manage daily life without alcohol is a critical component of AUD rehabilitation. In addition, any co-occurring mental diseases causing alcoholism may also benefit from behavioral treatment.

Cognitive behavioral therapy: CBT teaches you to identify and stay away from the circumstances that make you most inclined to drink, as well as how to deal with other issues and behavior that could result in alcohol misuse.

Family therapy: This avoids the transfer of substance abuse from one generation to the next by assisting families in becoming aware of their own needs.

Brief interventions: The goal of brief interventions is to persuade the person to cut back on their drinking or change their detrimental drinking habits.

Motivational enhancement therapy: The goal is to increase your self-assurance and drive to give up drinking.

Medications

The FDA has currently approved three drugs for the treatment of alcohol use disorders. While not everyone will benefit from medication, many do, particularly when accompanied by behavioral treatment and support, finding it helpful in maintaining abstinence and reducing cravings.

Support Groups

Peer counseling is offered by mutual-support organizations that are based locally and online. Also, they can be beneficial during alcohol withdrawal and addiction treatment. Most communities provide group meetings at low or no cost, convenient times and places, and a growing online presence. Therefore, they can be especially beneficial to people in danger of relapsing into drinking.

A support group, such as SMART Recovery or Alcoholics Anonymous, can make you feel less alone and allow you to interact and learn from people with similar challenges.

In addition to preventing feelings of guilt and isolation, social support from friends and family and online or in-person support groups can give you a sense of stability and optimism for your sober future. Family members and close friends can also profit from this kind of assistance and may consider joining organizations like Al-Anon and Alateen.

Mutual-support groups can give a crucial additional layer of support when combined with the prescription drugs and behavioral therapy offered by medical professionals.

Coping With Alcoholism

You can take steps on your own to make it simpler to deal with and maintain your recovery in addition to receiving appropriate AUD treatment.

Understand Your Triggers

Staying sober during and after AUD treatment requires knowing what could cause you to relapse and having a plan in place for such triggers.

The common triggers might include the following:

• Emotional distress
• Stress
• Being around those who continue to use drugs or alcohol
• Environmental cues that cause cravings
• Financial or employment issues
• Relationship difficulties

Practice Self-Care

Building resiliency to life pressures without turning to alcohol is a key component of recovery. Practicing self-care (paying attention to your mental, physical, social, and spiritual well-being) can help. You will be better prepared to live your best if you try to care for your body and mind.

Outlook

Although many people with AUD do recover, setbacks are frequent for those undergoing treatment. Early professional intervention can stop a relapse into drinking. Behavioral therapy can help people avoid and overcome stressors that could cause drinking, such as stress. Moreover, medications might assist people in avoiding drinking when they may be more likely to relapse (e.g., passing away of a family member or divorce).

Resources:

• “Alcohol Use Disorder: MedlinePlus Genetics.” Alcohol Use Disorder: MedlinePlus Genetics, 1 Jan. 2018, medlineplus.gov/genetics/condition/alcohol-use-disorder.
• Schwandt, Melanie L., et al. “Childhood Trauma Exposure and Alcohol Dependence Severity in Adulthood: Mediation by Emotional Abuse Severity and Neuroticism.” Alcoholism: Clinical and Experimental Research, vol. 37, no. 6, Wiley, Dec. 2012, pp. 984–92. Crossref, https://doi.org/10.1111/acer.12053.
• Yang, Ping et al. “The Risk Factors of the Alcohol Use Disorders-Through Review of Its Comorbidities.” Frontiers in neuroscience vol. 12 303. 11 May. 2018, doi:10.3389/fnins.2018.00303
• Barve, Shirish et al. “Development, Prevention, and Treatment of Alcohol-Induced Organ Injury: The Role of Nutrition.” Alcohol research : current reviews vol. 38,2 (2017): 289-302.

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