Alcoholism
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Re-Entry you have a knack for asking me tough questions
This is not as easy as one might imagine, for an entity [as I'll call it now] such as alcholism, is difficult to define, but there are guidelines.
In order to correctly answer this I have to precisely define a few terms.
1. Signs-subjective complaints i.e Chest pain
2. Symptoms-objective complaints i.e bleeding.
3. Disease-an entity that causes subjective and objective interuption of normal physiology accompanied by an interuption in physical well being
4. Syndrome-a specific conglomerate of signs and symptoms that is itself a disease or several abnormal elements linked to a specific cause.
example: Horner's syndrome, symptoms are unilateral: ptosis [drooping eylid one one side], miosis [constricted pupils], anhidrosis [no sweat-litterally
].
is usually caused by a lung tumor [Pancoast's tumor] that stimulates the nervous system-this is the disease. the symptom is the Horners syndrome, that in itself comprises several symptoms
the reason I was so specific [although some of the above is more my opinion than a hard set fact, and there's plenty of debate on these issues] is that it lays a frame work for what I will have to say later.
I can't finish now 'cuz my bro's coming outta the shower soon
but I want my further comments to be understood [at least where my mind is at], so folks can see my perspective and understand what my definitions mean.
Rule Books Are Paper They Will Not Cushion A Sudden Meeting Of Stone And Metal: E. K. Gann
rhov
This is not as easy as one might imagine, for an entity [as I'll call it now] such as alcholism, is difficult to define, but there are guidelines.
In order to correctly answer this I have to precisely define a few terms.
1. Signs-subjective complaints i.e Chest pain
2. Symptoms-objective complaints i.e bleeding.
3. Disease-an entity that causes subjective and objective interuption of normal physiology accompanied by an interuption in physical well being
4. Syndrome-a specific conglomerate of signs and symptoms that is itself a disease or several abnormal elements linked to a specific cause.
example: Horner's syndrome, symptoms are unilateral: ptosis [drooping eylid one one side], miosis [constricted pupils], anhidrosis [no sweat-litterally
].is usually caused by a lung tumor [Pancoast's tumor] that stimulates the nervous system-this is the disease. the symptom is the Horners syndrome, that in itself comprises several symptoms
the reason I was so specific [although some of the above is more my opinion than a hard set fact, and there's plenty of debate on these issues] is that it lays a frame work for what I will have to say later.
I can't finish now 'cuz my bro's coming outta the shower soon
but I want my further comments to be understood [at least where my mind is at], so folks can see my perspective and understand what my definitions mean.
Rule Books Are Paper They Will Not Cushion A Sudden Meeting Of Stone And Metal: E. K. Gann
rhov
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Disease-an entity that causes subjective and objective interuption of normal physiology accompanied by an interuption in physical well being
So is mental illness, a disease under this definition? Are we always that objective about it's diagnosis?
What about the ageing process? When does interuption become disruption?
When does drinking alcohol affect well being? And what exactly is well being?
And where does "health" fit into the the equation?
And who's gonna answer all these blooming questions?
And who decides health, the doctor? Or the patient? (Or the Goverment)
Last edited by gingernut; 1st Sep 2006 at 07:29. Reason: sober in the morning
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Nicked from wikipedia, but covers the differences pretty much:
So with that in mind I'd say that alcoholism is a disease.
Syndromes, illness and disease
Medical usage sometimes distinguishes a disease, which has a known specific cause or causes (called its etiology), from a syndrome, which is a collection of signs or symptoms that occur together. However, many conditions have been identified, yet continue to be referred to as "syndromes". Furthermore, numerous conditions of unknown etiology are referred to as "diseases" in many contexts.
Illness, although often used to mean disease, can also refer to a person's perception of their health, regardless of whether they in fact have a disease. A person without any disease may feel unhealthy and believe he has an illness. Another person may feel healthy and believe he does not have an illness even though he may have a disease such as dangerously high blood pressure which may lead to a fatal heart attack or stroke.
Disease can be thought of as the presence of pathology, which can occur with or without subjective feelings of being unwell or social recognition of that state; Illness as the subjective state of "unwellness", which can occur independently of, or in conjunction with disease or sickness; and sickness as the social classification of someone deemed diseased, which can also occur independently of the presence or absence of disease or illness. So someone with undetected high blood pressure who feels well would be diseased, but not ill or sick. Someone with a diagnosis of late-stage cancer would be diseased, probably feeling quite ill, and recognized by others as sick. A person incarcerated in a totalitarian psychiatric hospital for political purposes could arguably be then said to not be diseased, nor ill, but only classified as sick by the rulers of a society with which the person did not agree. Having had a bad day after a night of excess, one might feel ill, but you would not be diseased, nor is it likely you could convince your boss to recognize you as sick.
Sickness confers the social legitimization of certain benefits, such as illness benefit, work avoidance and being looked after by others. In return, there is an obligation on the sick person to seek treatment and work to become well once more.
Medical usage sometimes distinguishes a disease, which has a known specific cause or causes (called its etiology), from a syndrome, which is a collection of signs or symptoms that occur together. However, many conditions have been identified, yet continue to be referred to as "syndromes". Furthermore, numerous conditions of unknown etiology are referred to as "diseases" in many contexts.
Illness, although often used to mean disease, can also refer to a person's perception of their health, regardless of whether they in fact have a disease. A person without any disease may feel unhealthy and believe he has an illness. Another person may feel healthy and believe he does not have an illness even though he may have a disease such as dangerously high blood pressure which may lead to a fatal heart attack or stroke.
Disease can be thought of as the presence of pathology, which can occur with or without subjective feelings of being unwell or social recognition of that state; Illness as the subjective state of "unwellness", which can occur independently of, or in conjunction with disease or sickness; and sickness as the social classification of someone deemed diseased, which can also occur independently of the presence or absence of disease or illness. So someone with undetected high blood pressure who feels well would be diseased, but not ill or sick. Someone with a diagnosis of late-stage cancer would be diseased, probably feeling quite ill, and recognized by others as sick. A person incarcerated in a totalitarian psychiatric hospital for political purposes could arguably be then said to not be diseased, nor ill, but only classified as sick by the rulers of a society with which the person did not agree. Having had a bad day after a night of excess, one might feel ill, but you would not be diseased, nor is it likely you could convince your boss to recognize you as sick.
Sickness confers the social legitimization of certain benefits, such as illness benefit, work avoidance and being looked after by others. In return, there is an obligation on the sick person to seek treatment and work to become well once more.
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After that short and interrupted introduction, I will say that alcoholism is a disease, but what is alcoholism?
There are two type of alcohol consumption:
1. Use-most folks do this
2. Abuse Most folks have done this
As can be seen from the above that, neither criteria is actually alcoholism, but alcoholism of course involves both.
To be more concrete let's go over two other concepts under the general rubric of dependence:
1. Psychologic manifested by cravings, and behavior with the ultimate goal of securing the substance or entity to which one is addicted
2. Physiologic-determined by symptoms of withdrawal caused by a BIOCHEMICAL dependence:
Now finally alcoholism
This disease is manifested as a syndrome that is characterized by
1. Physiologic- dependence there is evidence of withdrawal, that can at times for some in the advanced stage be dangerous
2. Tolerance- the effects of alcohol actually diminish
3. Evidence of alcohol associated disease. Liver disease, cerebellar degeneration
4. Continued drinking despite a medical, legal, occupational, financial or social consequences
6 Depression
7. 'Black outs'
These are the symptoms.
The signs include:
Alcohol always on breath, flushed face,work absences, sneaking drinks, nerve pain and damage, cigarrette burns, skin changes, accidents and frequent injurys:
and physiological changes include liver enzyme elevation and increase in the volume of red blood cells and many others.
If these criteria are sufficient to impair life functions then one has the disease alcoholism.
Next time I'll talk more about withdrawal and treatment, as well as alcohol use being a sign and symptom of other Illnessneses because of the strong phychological and physical components inherent to this disease.
...Yes, Gingernut, mental illnesses are diseases...but we'll talk about in another thread, for now I'll talk about mental illness in the context of alcoholism/use and abuse, but some practical definitions must be given on order to make the topic clear and to not sound judgemental.
btw, I'll start the EKG/heart thread for pilots some time early next month , been real busy 
TurboCompressors OFF
rhov
There are two type of alcohol consumption:
1. Use-most folks do this
2. Abuse Most folks have done this
As can be seen from the above that, neither criteria is actually alcoholism, but alcoholism of course involves both.
To be more concrete let's go over two other concepts under the general rubric of dependence:
1. Psychologic manifested by cravings, and behavior with the ultimate goal of securing the substance or entity to which one is addicted
2. Physiologic-determined by symptoms of withdrawal caused by a BIOCHEMICAL dependence:
Now finally alcoholism
This disease is manifested as a syndrome that is characterized by
1. Physiologic- dependence there is evidence of withdrawal, that can at times for some in the advanced stage be dangerous
2. Tolerance- the effects of alcohol actually diminish
3. Evidence of alcohol associated disease. Liver disease, cerebellar degeneration
4. Continued drinking despite a medical, legal, occupational, financial or social consequences
6 Depression
7. 'Black outs'
These are the symptoms.
The signs include:
Alcohol always on breath, flushed face,work absences, sneaking drinks, nerve pain and damage, cigarrette burns, skin changes, accidents and frequent injurys:
and physiological changes include liver enzyme elevation and increase in the volume of red blood cells and many others.
If these criteria are sufficient to impair life functions then one has the disease alcoholism.
Next time I'll talk more about withdrawal and treatment, as well as alcohol use being a sign and symptom of other Illnessneses because of the strong phychological and physical components inherent to this disease.
...Yes, Gingernut, mental illnesses are diseases...but we'll talk about in another thread, for now I'll talk about mental illness in the context of alcoholism/use and abuse, but some practical definitions must be given on order to make the topic clear and to not sound judgemental.
btw, I'll start the EKG/heart thread for pilots some time early next month
, been real busy TurboCompressors OFF
rhov
Last edited by rhovsquared; 1st Sep 2006 at 20:21. Reason: grammar/clarity
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Thanks rhov, I've got many patients who exhibit some of the signs and some of the symptoms of alcoholism you so eloquently describe.
Not one of them would describe themselves as diseased though, and most may not have the prescence of pathology, as fd defines.
We could go round the houses discussing when use becomes abuse, but, as medics, when do we decide that a problem is a problem?
Not one of them would describe themselves as diseased though, and most may not have the prescence of pathology, as fd defines.
We could go round the houses discussing when use becomes abuse, but, as medics, when do we decide that a problem is a problem?
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Phew, finally some time to get back to this thread, very sorry if anyone wanted a more prompt response and subsequently lost interest
I have been doin' the runaround lately and only had a finite time to make a few short blurbs.
First I think I'll preface this with a brief discussion into the metabolism of alcohol. All alcohols are metabolized in the the liver by an enzyme Alcohol dehydrogenase. this enzyme oxidized the OH- group of the alcohol into its corresponding aldehyde..i.e methanol [one carbon] is turned to formaldehyde ethanol is turned into [acetaldehyde] ethaldhyde.
Aldehyde are for the most part toxic to cells..and while small intermittent exposures to even relatively large amounts of alcohol is dealt with via the above pathway with the aldehydes being eliminated constant exposure fills the active site of the enzyme and causes a sort of backlog on the metabolism of alcohol. Also, this reaction since it is a reduction/oxidation type of reaction depends on the agent NADH [nicotinamide adenine dinucleotide] Nicotinic acid it is an electron acceptor and it's precursor is an important vitamin [nicotinic acid] and therefore also has a role in preventing cellular damage. the backlog and the depletion of important vitamins is what is responsible for the cellular toxicity of alchohol this... and also its excretion with both aldehyde and alcohol being directly toxic to the kidneys in large amounts ...the above is the primary reason alcohol is dangerous to the body in excess amounts Cellular damage [brain cells and nerve cells, kidney cells liver cells, skin etc.]
Another problem faced is the fact that people who drink tend to have poor diets and do not receive adequate amounts of nutrients [especially thiamine] this can result in impaired mental function and at its worst dementia this can result in something called Wernicke's encephalopathy
[alcohol dementia].
After hearing such facts well some might say well then just stop drinking, but that not so easy... these are the reasons why
1. co-morbid problems usually result with alcoholism...usually depression/ anxiety and that can lower all incentives to stop in fact these problems may precipitate the onset of chronic drinking in the first place
2. Withdrawal can be dangerous for folks that have been doing so in large amounts for long periods resulting in delirium or even seizure and coma
3. social awareness of alcoholism as [and all substance abuse] is not present in the general public and having such a problem carries with it a stigma
4.treatments involves patient compliance and without treatment of co-morbid factors [like depression] often goes undone.
5. As Gingernut has said there is usually a strong factor of denial [and denial is more than just a river in Africa]
causes even the best treatments to go downstream with out much efficacyTreatment:
well, firstly one should attmept to address any comorbid fctors such as depression
A strong yet nonjudgmental social support network [like alcoholic anonymous]
is also key
One point is that aversive methods [apomorphine or antabuse] although a valid clinical option requires a strong will from the patient [they really all do Hence Gingernut's frustration]
To deal with the inevitable withdrawal [and this will present a problem for pilots] Diazepam [no, I don't work for Eli Lilly
] in high doses may have to be given especially to patients with an advanced course up to 10mg every four hours and this mediaction especially in high doses is aDdictive but may be ABSOLUTEY NECESSARY TO PREVENT A DANGEROUS EVEN LIFE THREATENING WITHDRAWAL.Lastly, I will add there must be a strong motivation on the part of the person with alcoholism to stop drinking that's the hard part
Once again, I'm sorry for my tardy reply and when I nsaid I'll start the EKG thread 'sometimes early next month well I didn't realize it was still august I really meant early in October
The Choice Between (i) Hitting The Ground With The Nose Up... or (ii) Hitting the Ground With The Nose Down...D.P.D Taken way Outta Context
rhov
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This is a very old thread but I have just had an acquaintance die of from Gordon's Gin Syndrome. 65 yrs old but just couldn't kick the habit. A good friend who is 45 was warned to give it up or he would die. He went into very expensive rehab in Norway and we thought that he was doing really well (6 months dry). Just last week he fell off the wagon and has had to be taken away again just today. Neither aircrew by the way.
We have three friends who have been off the pop for years after problems.
My wife is a nurse and says that there is only 10% chance of anyone kicking this habit even after rehab.
Sure I drink too much but do not fall into this bracket.
Just interested in other people's opinion on the chances of staying dry if a problem is identified. I am still a little shocked about having to put my good friend on the ship today - he was not too sober I must add
We have three friends who have been off the pop for years after problems.
My wife is a nurse and says that there is only 10% chance of anyone kicking this habit even after rehab.
Sure I drink too much but do not fall into this bracket.
Just interested in other people's opinion on the chances of staying dry if a problem is identified. I am still a little shocked about having to put my good friend on the ship today - he was not too sober I must add
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Different people react differently to alcohol. I used to make homebrew beer and wine but packed it in when I put on weight. Giving it up caused me no problems. I would still have the odd glass of wine or can of beer occasionally but cannot have alcohol now due to medication. It doesn't worry me at all and I don't miss it. I'm just as happy with a glass of squash, which doesn't rot my liver!!
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I personally dont think its a disease, they just use it as an excuse and then the government goes and calls it a disability so they go and gets loads more disability money.
What does this lead to??
Well they buy more drink.
I dont drink a drop as im T-total and i dont miss it at all, im actually happier without it
What does this lead to??
Well they buy more drink.
I dont drink a drop as im T-total and i dont miss it at all, im actually happier without it
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I personally dont think its a disease, they just use it as an excuse and then the government goes and calls it a disability so they go and gets loads more disability money.
OK in which case why do medical insurance companies refuse to cover you for said 'disease'?
