Description/Etiology
Alcohol abuse (AA) is characterized by intentional, routine alcohol consumption that causes self-harm or harm to others. AA is observed when an individual engages in the following behaviors regularly over a 1-year period: missing work or shirking childcare responsibilities because of drinking, drinking in dangerous situations (i.e., while driving, operating machinery), being arrested or hurting someone while under the influence of alcohol, and drinking regardless of ongoing social, work, and school alcohol-related tensions. Alcohol dependence (AD) is characterized by the excessive use of alcohol regardless of alcohol-related problems and physiologic tolerance or withdrawal. AA and AD operate along a continuum—without intervention AA may lead to AD.
Alcohol is a central nervous system (CNS) depressant that impairs judgment, reaction time, balance, motor skills, speech, and, at high levels of consumption, consciousness. Women are at risk for alcohol intoxication after drinking less alcohol than men because women have less total body water content (TBWC) than men: when alcohol diffuses into total body water, the concentration of alcohol for women rises more quickly. Further, in women, little alcohol is metabolized by first-pass metabolism in the stomach because women produce less gastric alcohol dehydrogenase than men; rather, it is metabolized later as blood circulates throughout the body. Monthly hormonal changes may also affect the rate of alcohol metabolism.
Women who abuse alcohol drink as a coping mechanism for stress, social problems (i.e., abuse, sexual abuse, intimate partner violence, poverty), mood disorders (i.e., depression, anxiety), and low self-esteem. Genetic factors account for 50–60% of the susceptibility to alcoholism and environmental factors such as stress contribute to alcohol abuse which results in an increased corticotropin-releasing factor and a hyperglutamatergic state that may result in increased alcohol seeking behavior, which can lead to alcohol abuse and dependence.
For women, excessive alcohol consumption is defined as having > 7 drinks (i.e., 12 ounces of beer, 8 ounces of malt liquor, 5 ounces of wine, 1.5 ounces of spirits or liquor) per week. When women with AD stop drinking, they may experience alcohol withdrawal syndrome—characterized by symptoms ranging from sleep changes, anxiety, irritability, diarrhea, and sweating to delirium, hallucinations, catatonia, seizures, and convulsions.
Women with AA and AD are more likely than men to have alcohol-related health problems. AA and AD in women are associated with increased risk of liver disease (i.e., cirrhosis), cancers (i.e., breast, rectum, liver, mouth, throat, esophagus), stroke, coma, and death. AA and AD in women are linked to increased risk for automobile accidents, experiencing violence (i.e., dating, intimate partner, sexual assault), and sexually transmitted diseases as consequence of high-risk behaviors associated with AA. Women who develop AA and AD often develop psychiatric disorders (i.e., alcohol abuse-related eating disorders, mood disorders) and experience more suicide attempts (40% vs. 90%) than men with AA or AD. Younger women with AA and AD are more likely to attempt suicide than older women with AA and AD.
Treatment for AA and AD is multifactorial. Disulfiram, used to treat chronic AA and AD, quickly induces an adverse reaction in the presence of alcohol. Disulfiram inhibits the normal breakdown of alcohol by alcohol dehydrogenase, causing excess blood acetaldehyde which induces nausea, vomiting, headache, and chest pain. Support groups (i.e., Alcoholics Anonymous), cognitive-behavioral therapy, patient education about healthy lifestyle, and emotional support are effective treatment tools for some women with AA and AD.
Supportive care during alcohol withdrawal should include physical exam to identify and treat arrhythmias and heart function, liver and pancreatic disease, infectious diseases, unstable vital signs, fluid and electrolyte disturbances, and mineral deficiencies. Patient safety is critical due to risk for falls and seizure. Benzodiazepines are the drug of choice used to treat anxiety, insomnia, and seizures. Antiseizure medications (i.e., carbamazepine, valproic acid) may also be used to prevent seizures.