Alcohol Dependence


                13% lifetime prevalence among Americans per ECA data

        Genetics:  Strong evidence supports the assertion that alcohol dependence is a strongly genetically-based disorder.

                30% prevalence among first degree relatives of alcoholics.
                35% prevalence among fraternal twins.
                70% prevalence among monozygotic twins.
                        - the biggest predictor of alcoholism in adopted away children is alcoholism in the
                            biological parents; presence of alcoholism in the adoptive parents had no impact on
                            the development of alcoholism.

        Note that although 70% of monozygotic twins of alcoholics develop alcohol dependence, 30% don't, indicating environment must play at least some role in the expression of this disorder.

        Diagnosis:    Asking a patient "How much do you drink?" is next to useless.  It is the overall pattern of drinking, as well as the consequences of drinking, that really matters.  The mose useful screening tool is the CAGE questionaire.  Also useful:  the medical chart and information from the patient's family (permission must first be obtained from the patient before you talk to them).  Always consider other substances of abuse when exploring a patient's alcoholism (e.g., cocaine, amphetamines).

        Treatment:  The treatment of alcohol dependence can be divided into acute treatment of withdrawal (detoxification) and long-term treatment of the underlying dependence with a goal of abstinence (recovery).