see ((Alcoholism))
Criteria used to diagnose alcohol use disorder (AUD) are based on neurobiological changes due to excessive alcohol use that contributes to predictable patterns of drinking and other behaviors.
AUD is a chronic relapsing and remitting syndrome with excessive drinking of alcohol persisting, despite causing health and social problems.
AUD is a leading contributor to illness and death and frequently not diagnosed but is creates a burden of disease that is high, estimated between 29 million people being affected by this disorder.
AUD led to approximately 178,000 deaths in 2021, a health burden that is approximately two times that associated with the use of opioids.
Alcohol use contributes to injuries and many diseases, including malignancies of the oropharynx, esophagus, liver, colon, rectum, and breast, and also liver disease such as hepatitis and cirrhosis.
People at risk of harm from alcohol use include: young people who are vulnerable to injuries and accidents, older people who are at increased risk of complications of the interaction of alcohol and medications, such as opioids, benzodiazepines, anti-depressants, and antihistamines and alcohol attributable falls.
Alcohol use in pregnancy creates a risk of fetal alcohol syndrome.
Alcohol, like other addictive drugs, stimulates regions of the brain associated with reward by releasing the neurotransmitter dopamine, which reinforces behavior and increases the likelihood that a behavior will be repeated.
In patients with AUD, dopamine increases in brain regions associated with reward in anticipation of alcohol use results in strong physiological cravings.
Such adaptations can lead to reduced enjoyment from every day experiences, resulting in low mood and the prioritization of alcohol use above other daily activities.
Chronic alcohol use increases reactivity to stress, further contributing to motivations to drink.
Excessive alcohol use affects the prefrontal brain areas associated with self regulation, decreasing one’s ability to resist cravings or impulses to use alcohol.
Alcohol use disorder has mythically been believed to result from a moral failure, and has influenced public and professional views of the process.
An estimated 50% of the risk of alcohol use disorder is thought to be inherited.
Mental health disorders are associated with a double risk of alcohol use disorders.
Adverse early life experiences an adult traumas reportedly increase risk for AUD.
Alcohol use is associated with approximately 3 million deaths per year globally.
However, chronic heavy alcohol use results in reductions in dopamine release and decreased density of dopamine receptors, as well as physiological tolerance to alcohols effects.
Repeated exposure to alcohol the neurotransmitter responses are blunted: this results in increasing doses of alcohol needed to produce the same effect, and alcohol withdrawal syndrome emerges when high levels of consumption are reduced or ceased.
Alcohol consumption activates the reward regions of the brain, increases the release of dopamine and the additional involvement of endogenous opioids, gamma aminobutyric acid, endocannbinoids and other neurotransmitters.
The reward system projects to the orbital terminal contacts and provides a pathway for alcohol to influence decision-making, including, impaired inhibitory control.
US deaths attributed to alcohol exceed 140,000 annually and account for one and five deaths among US adults age 20 to 49.