Talk:Alcoholism

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This article is about Alcoholism. Discussions regarding the Disease Theory of Alcoholism have been moved to their own page, so please discuss that topic on that page, and we will summarize the results in this article.

This article has special considerations because a thorough examination of the available information on alcoholism indicates that there are at least two forms of alcoholism with no professional differentiation between them. Those who study one of them tend to insist that their form is the one and only true alcoholism, and this has resulted in a great deal of professional disagreement. The following few paragraphs are a description of these two forms based on research performed while writing this article. This should not be considered authoritative, and cannot go into the main article due to "original research" limitations, but I am presenting it here as a guide for those who wish to contribute to the article, to help them understand the considerations that have gone into it.

The first is the psychological/social addiction which comes about during a period of a person's life when alcohol consumption is of significant benefit to a person. This period may be a one time thing (like during college or after a divorce), or it may be a recurring thing (like that semi-annual girls night out or company party). This perception of benefit is often carried over for a considerable time after the benefit ceases to exist. This form of alcoholism can run rampant across the person's life until others help them realize that alcohol isn't providing benefit to match the problems it's causing.

The second form of alcoholism is a physiological condition in which the person's endorphin system convinces them that drinking alcohol is beneficial to them. It is essentially identical to a morphine or heroin addiction (endorphin being "endogenous morphine"), but is triggered by the consumption of alcohol (which releases endorphins into our system), and therefore alcohol consumption is the behavior that it reinforces. This form of alcoholism completely defies logic and sensibility, and often requires severely traumatic consequences to occur before the alcoholic is willing to admit that they have a problem. Even then they are often unable to quit drinking without assistance.

This results in several misperceptions of alcoholism. The most damaging one is due to differences in endorphin production and reception. Only about one sixth of the population is susceptible to the second form of alcoholism. This means that the majority of people who have suffered from the first type don't understand why the second type can't just quit.

In any case, the word Alcoholism does apply to both forms without differentiation, and therefore you will notice a few compromises in this article which are designed to reflect that unofficial duality.

Robert Rapplean 21:53, 28 September 2006 (UTC)

Contents

[edit] genetic testing

At least one genetic test[3] exists for a predisposition to alcoholism and opiate addiction. Human dopamine receptor genes have a detectable variation referred to as the DRD2 TaqI polymporphism. Those who possess the A1 allele variation of this polymorphism have a small but significant predisposition towards addiction to opiates and endorphin releasing drugs like alcohol[4]. Although this allele is more common in alcoholics and opiate addicts, it is by itself inadequate to explain the full effect of, or be a reliable predictor of alcoholism.

Which would it be, the small yet significant predisposition, or inadequate to explain/be a predictor to alcoholism? If it isn't significant, the word significant could be removed and it'd be fine. If it is, I'd say how that plays into its role as an indentifier but not a predictor. The wording is just a little ambigious here (one of those wtf moments). JoeSmack Talk(p-review!) 15:51, 29 September 2006 (UTC)

I think it's a usage issue. Maybe "small but statistically significant" is the proper phrase. It doesn't explain, predict, or identify an alcoholic. A person with this allele may be able to drink alcohol with no addictive results. However, this allele is slightly more common in those who have shown addiction to alcohol than in those who have shown the lack of this behavior. This suggests that, if all other things are equal the existence of the allele encourages people towards alcoholism, but that there are other factors and/or alleles that have a much stronger effect. Would you care to suggest an alternate phrasing that states this better? Robert Rapplean 19:07, 1 October 2006 (UTC)
i find this a little less cloudy:

At least one genetic test[3] exists for an allele that is correlated to alcoholism and opiate addiction. Human dopamine receptor genes have a detectable variation referred to as the DRD2 TaqI polymporphism. Those who possess the A1 allele variation of this polymorphism have a small but significant tendancy towards addiction to opiates and endorphin releasing drugs like alcohol[4]. Although this allele is slightly more common in alcoholics and opiate addicts, it is not by itself an adequate predictor of alcoholism.

I added the words 'correlated' and 'tendancy' so that the word 'predisposition' isn't used, as later it is stated it isn't an adequate 'predictor'. hope that clears things up. JoeSmack Talk(p-review!) 23:41, 1 October 2006 (UTC)

[edit] screening

i think that the screening section either should be the CAGE questionnaire and one more example, or they all need to be flushed out in more detail. right now it looks like a bunch of edits people crammed together. JoeSmack Talk(p-review!) 16:08, 29 September 2006 (UTC)

P.S. The DSM-IV diagnosis of alcohol dependence represents another approach to the definition of alcoholism, one more closely based on specifics than the 1992 committee definition. - wtf is the 1992 committee definition? not mentioned anywhere else. JoeSmack Talk(p-review!) 16:11, 29 September 2006 (UTC)

You've done a very good job of fleshing this out. I think at this point we might want to resort to listing them (like in the terminology section) and making sure we provide them with equal coverage.
The 1992 committee definition refers to something that was pulled out or moved away. Such statements that compare themselves favorably to other statements in the article were fairly common when we had many people contending for dominance on this article, and I haven't fully removed them all yet. This statement should be made to be more self-contained. Robert Rapplean 19:07, 1 October 2006 (UTC)
Done, done. JoeSmack Talk(p-review!) 23:29, 1 October 2006 (UTC)
The standard definition for alcoholism in the medical field is the 1992 committee definition that was here when that paragraph was written. The article, "The Definition of Alcoholism," was published in JAMA on 8/26/92 (Vol 268, #8, p1012) and was the result of work by the Joint Committee of the National Council on Alcoholism and the American Society of Addiction Medicine. The entire definition was part of this article originally and probably should be again: "Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions of thinking, most notably denial. Each of these symptoms may be continuous or periodic." The article goes on to define each term within the definition to a greater extent. For the past 14 years, this definition has been accepted by the medical community and provides the descriptive basis upon which physicians treat addictive disease, alcoholism in particular. Drgitlow 00:58, 18 October 2006 (UTC)


Ah, right. That was part of the introduction that we had such extensive disagreement about. For those who are new to this, you can find much of that argument in Archive 3. The short version is that a lot of it was replaced because it used categorizations that are not comprehensible to the average reader. It also resulted in the moving of the disease discussion to its own page. Robert Rapplean 17:04, 18 October 2006 (UTC)


I would like to suggest the addition of Internet-based alcohol screening resources available as a public service, as they can be very useful. One such resource is AlcoholScreening.org, devleoped by Boston University School of Public Health (full disclosure: I helped develop this website). This site provides screening results based on the AUDIT and U.S. Dietary guidelines for alcohol consumption. There is at least one such site in the United Kingdom based on its health service guidelines, one in Australia, and so on. There are a few such commercial services as well, although I am initially inclined to list only those Internet public service (free) screening sites which are sponsored by a credible source, i.e. a University, qualified health facility, or a governmental health agency. These tools do not exclusively screen for alcohol dependence (alcoholism) but also cover hazardously excessive consumption that may cause future problems or put one at risk for immediate consequences such as accidents. The best ones are nonjudgemental and non-labeling. I am quite willing to contribute this content, but I would appreciate guidance on where and how to do so. Should this be a new item under Screening? Should it go at the end under "see also?" Other suggestions? Eric Helmuth 02:39, 15 November 2006 (UTC)

Hello and welcome, Eric. I looked through the screening on alcoholscreening.org and think that it's at least as valid as any other screening I've seen, and would be useful for people to confidentially understand how much of a problem their drinking is from an objective perspective. My view would be to just drop the content at the end of the Screening section, with an introductory sentence something like "Many free screening resources exist online...". It will likely be mulled over after that and may be reformatted. I'm not currently very happy with the "list quality" of that section, and would prefer a short paragraph describing the advantages and disadvantages of each screening type, but feel it's important enough to know that online confidential screening exists for this inclusion. Other opinions? Robert Rapplean 19:03, 15 November 2006 (UTC)
Thanks for the warm welcome, Robert. I can't make the edit right now due to the protected status of the page, so others should feel free to add it if desired; otherwise I'll wait until my account clears. - Eric --WikkiTikkiTavi 02:18, 17 November 2006 (UTC)
I'm now able to edit and have added some minimal information as suggested. Sugggestions for expansion and improvement are welcome. Eric Helmuth

[edit] images

i found these two images over in the wikimedia commons [1]:

...and this article could use a little imagery. the top was given from a german contributor, and the bottom from an icelandic (here is a site for its explaination, hope someone speaks the language [2]). either way, i hate to see an article go without images but i also don't know the context of these two pictures too well as they are in a foriegn tounge. anyone game to try and incorporate one or both? JoeSmack Talk(p-review!) 20:43, 29 September 2006 (UTC)

I agree strongly that the article needs images. Where would you put these and to illustrate what?--Twintone 21:03, 29 September 2006 (UTC)
There in lies the problem; a simple sentence about the era these images are from in the description of the thumb would do, but both sources are in languages other than english. Anyone know someone who speaks German or Icelandic? Actually, thats a dumb question, i'll look around the Babel categories, unless someone beats me to it. JoeSmack Talk(p-review!) 22:19, 29 September 2006 (UTC)
I'm going out for the night, but in case anyone wants to beat me to it before tomorrow, here ya go [3]! :) JoeSmack Talk(p-review!) 00:49, 30 September 2006 (UTC)
Look what I foooooound: [4]. JoeSmack Talk(p-review!) 18:39, 30 September 2006 (UTC)

I tracked down the original and recropped it to get a bigger picture out of it. I've added it to the article. Here it is:

Enlarge

JoeSmack Talk(p-review!) 18:59, 30 September 2006 (UTC)

I like where you put that one, it makes a good opening. I think someone took offense to the images that were in here a while ago, because there used to be many more. I'd really like to see more informational images (like statistical charts or whatnot) because most of the "alcoholism" images tend to be ominous pro-prohibition woodcuts and whatnot, and too much of that can be very offputting to readers. I'll keep an eye out. Robert Rapplean 19:13, 1 October 2006 (UTC)

Tah-rue. Some info graphs on statistics would be excellent. I'll see what I can do too. JoeSmack Talk(p-review!) 23:16, 1 October 2006 (UTC)


[edit] Rationing section

Some programs attempt to help problem drinkers before they become dependents. These programs focus on harm reduction and reducing alcohol intake as opposed to abstinence-based approaches. Since one of the effects of alcohol is to reduce a person's judgement faculties, each drink makes it more difficult to decide that the next drink is a bad idea. As a result, rationing or other attempts to control use are increasingly ineffective if pathological attachment to the drug develops.

Nonetheless, this form of treatment is initially effective for some people, and it may avoid the physical, financial, and social costs that other treatments result in, particularly in the early phase of recovery. Professional help can be sought for this form of treatment from programs such as Moderation Management.

This section to me seems like a long-winded way of saying there are harm-reduction programs (i.e. non-zero-tolerance approaches). This is mentioned in the Treatments section that is short but done pithily. Anyone object to me removing this section? JoeSmack Talk(p-review!) 16:47, 2 October 2006 (UTC)

'Fraid so. Rationing is a viable treatment option that is significantly different from the others mentioned. This section provides a good overview of it, as it describes the advantages and disadvantages of this approach. However, We should seriously consider combining that with the "return to normal drinking" section, since they are functionally identical. Robert Rapplean 17:42, 2 October 2006 (UTC)

[edit] Detoxification Section

FYI, I feel that it's important to emphisize that detox is not a treatment for alcoholism, but a method for reversing the metabolic imbalance caused by regular alcohol use. It does nothing at all to curb the desire to drink. I'm ok with this statement being dropped to the third paragraph, though. Robert Rapplean 18:15, 2 October 2006 (UTC)

[edit] Naltrexone

There are currently two ways that naltrexone is used, and the two are strongly in contention. Naltrexone was ok'd by the FDA for use for alcoholism in 1995.

The FDA site suggests that people not drink when taking naltrexone. It is generally prescribed to alcoholics as a way of helping them maintain abstinance, for which it has a very small effect for some people. There is a great deal of research (see above) that suggests that, on the average, naltrexone has questionable value in maintaining abstinance. As a result most doctors will do one of three things: provide naltrexone with the instructions to avoid drinking, cocktail naltrexone with antabuse to specifically discourage drinking, or avoid naltrexone whatsoever.

Pharmacological extinction specifically requires the alcoholic to drink while on naltrexone, preferably where and when they normally drink. The FDA's standard instructions specifically prevent PE from occuring, and coctailing it with antabuse is even worse. PE has a success rate of about 87% for converting serious alcoholics into people who can forget alcohol exists from one day to the next, and have no problem with drinking socially.

Unfortunately, most people think that the drug IS the treatment, and as such the two treatments get confused, very much like what you did in your recent edit. This results in most people thinking that the "naltrexone to maintain abstinence" results reflect on the "naltrexone to cause extinction" treatment. It may take extra explaining to maintain the differentiation. Robert Rapplean 18:07, 2 October 2006 (UTC)

[edit] 'result'

the word 'result' is used 18 times in this article. i'll start to try and get the wording more varied, but please for a while hold off on using that danged word. it gets tiring. :) JoeSmack Talk(p-review!) 16:41, 4 October 2006 (UTC)

it's now down to 4-5. thats better; it really does make it read a lot nicer. i once had a english teacher who told us to write a 8-10 sentence piece about anything that happened the week before. afterwards he told us to count the uses of the verb 'to be'. replacing this verb with any other verb makes it a much more descriptive piece. this article's removal of the word 'result' is something similar. JoeSmack Talk(p-review!) 17:39, 4 October 2006 (UTC)

[edit] sinclair method/Pharmacological extinction

There is a lot of professional resistance to this treatment for two reasons. Pendery et al in 1982[1] demonstrated that controlled drinking by alcoholics was not a useful treatment technique. Many studies have also been done which demonstrate naltrexone to be of questionable value in supporting abstinence.[2][3][4](et. al.) For those who don't understand the mechanism involved, these results have been assumed to demonstrate the ineffectiveness of the two treatments in combination. This logic isn't applicable because it assumes that the two treatments are merely complementary, like two people pushing a car, as opposed to sequential, like turning a doorknob and then pulling on it.

The Finnish study[5] indicated, "Naltrexone was not better than placebo in the supportive groups, but it had a significant effect in the coping groups: 27% of the coping/naltrexone patients had no relapses to heavy drinking throughout the 32 weeks, compared with only 3% of the coping/placebo patients. The authors' data confirm the original finding of the efficacy of naltrexone in conjunction with coping skills therapy. In addition, their data show that detoxification is not required and that targeted medication taken only when craving occurs is effective in maintaining the reduction in heavy drinking."

i'm not sure if this section of the Sinclair Method/Pharmacological extinction is supposed to be a critism aspect or anything, but right now its just a study abstract. the references these studies are connected to might be laced into other places as cites, but i don't think they should be getting 2/3rds of the section - especially as the first is heavily docked for being illogical. JoeSmack Talk(p-review!) 16:55, 4 October 2006 (UTC)

The last section can be summed up as "check out the actual studies for proof". It's really too technical for this article, so should be summarized or deleted. I believe it was put in there by a psychiatrist who was editing this article earlier, and was trying to adjust it to appeal better to medical professionals.
The middle paragraph is necessary because it describes the ongoing mental conflict that causes people to disregard a treatment option of unprecedented effectiveness. I'd appreciate an explanation of why you consider it illogical, because it scans pretty logically to me. Robert Rapplean 21:23, 4 October 2006 (UTC)

I'd be for deleting both unless the middle got a re-write. I called it 'illogical' as the final sentence says This logic isn't applicable because... which pretty much dashes some of the afore mentioned studies to the rocks. At least I think what thats refering too (which you might interpret as what X readers are thinking). Also the phrase For those who don't understand the mechanism involved immediately sets up a position of writer vs. reader, which feels, uh, condescending (i'm here to understand the mechanism involved). It is definitely not encyclopedic style writting.

The first paragraph to this section is great and clear, the 2nd and 3rd are foggy. There should be like one paragraph summarizing studies out there, it doesn't have to get too nitty gritty; thats what the sinclair article fork is for. JoeSmack Talk(p-review!) 17:02, 5 October 2006 (UTC)

This being the case, could I enlist your help in rewriting? Let me see if I can clarify what I'm trying to describe. Pharmacological extinction is a little like a [Glossary_of_wildland_fire_terms|backfire]. Setting fire to trees is known to make them burn. I don't need a study to prove that. Blowing air at large fires makes them burn faster. Again, easily provable. Each of these by themselves would only make a wildfire spread more quickly, and again, that's readily demonstrable. However, if you find a place where the wind is burning towards the fire and set fire at that place, the backfire will burn towards the main fire and consume all of the fuel in its path. This doesn't contradict our two starting facts, it just invalidates the idea that you can't combine the two in order to fight fire. Could you help me explain this? Robert Rapplean 22:30, 5 October 2006 (UTC)
I steer from the complex metaphor just a bit. Here is how i re-wrote it, tell me how you feel:

There is a lot of professional resistance to this treatment for two reasons. Studies have demonstrated that controlled drinking for alcoholics was not a useful treatment technique[21]. Other studies have also shown naltrexone to be of questionable value in supporting abstinence alone.[22][23][24]. The individual failure of these two separate treatments often lends to the idea that their use in combination is equally ineffective. Some assume that the two treatments are complementary, like two people pushing a car; others feel they are effective as they are sequential, like turning a doorknob and then pulling on it.

maybe throw that Finnish study ref in there as a nail on the coffin (as an inline cite, the last sentence will do as a summary)? JoeSmack Talk(p-review!) 05:28, 6 October 2006 (UTC)

I'm good with this, with the exception of others "feeling" that they are effective. Pharmacological extinction makes some pretty bold claims, and I've given it a monumental level of scrutiny, even going so far as to talk on the phone with all of the researchers involved, calling a good dozen treatment agencies, and have a chat with the head of the research department at the NIAAA. The comments about it tend to fall into one of three categories. (a) it's obviously proven to work, (b) studies show naltrexone is a waste of money and letting an alcoholic drink is like trying to put a fire out with gasoline, or (c) I haven't looked at it before, but it sure seems to make sense. I've examined studies out the wazoo (I'll give you a list if you like), and everything done on opiate antagonists and alcoholism either supports it or completely fails to address it. The only room for feeling here is those who don't feel that it's worth their time to look into, which unfortunately is damn near everyone. I think we'd be doing our readers a disservice by making such a weak statment about it. Robert Rapplean 22:02, 6 October 2006 (UTC)

Hmm, that last sentence still kinda bothers me too. The important thing to remember here is no original research (although it sounds like you've taken the time to be extremely erudite on the subject), and to be NPOV. I think you can explain the con side's shortcomings without making it unbalanced. Take a cut at that last sentence (try removing the metaphor, although good) and try to articulate the point in another way perhaps. UPDATE: Whoop, looks like you're doing that right now. JoeSmack Talk(p-review!) 22:13, 6 October 2006 (UTC)
Perhaps saying people presume that the effects are 'additive', where adding together two failure still means failure. However research shows the effects tend to be 'synergetic'; where each fails alone both can succeed together. JoeSmack Talk(p-review!) 22:17, 6 October 2006 (UTC)

It's a little more complicated than that. Attempting to moderate alcohol use actually enhances the addiction by increasing the endorphin conditioning, although more slowly than for excessive drinking. Similarly, naltrexone all by itself has no notable effect on the actual addiction if you don't drink. It slightly decreases the urge to drink while you're taking it, but there's a rebound effect when you stop taking it and the sum total results in effects slightly worse than if you don't take it at all. Synergy suggests that the two effects are minor on their own, but significant when used together, and that isn't the case. The two are actually negative when used alone.

I have to disagree with you there, [5]. 'Synergy' the word doesn't mean the two effects alone are minor, just that when the two combine the effect is greater than the sum of their individual effects.

Ok, strike "minor" insert "lesser". Nonetheless, in synergy the effect is only changed in magnitude, not in direction. That is where the difference lies. Robert Rapplean 19:10, 15 October 2006 (UTC)

The door example helps describe this. You turn the knob and pull on it, the door opens towards you. But let's say that the door is hinged to swing both ways, and there's a wind at your back. If you turn the knob without pulling on it under those conditions, the door will open away from you instead of toward you. Similarly if you pull on it without turning the knob you wedge the pin against the side of its hole, making it harder to turn the knob and open the door. Individually, the two efforts have a negative effect on the goal of getting the door to open towards you, but taken sequentially they work with little effort. 198.152.13.67 16:38, 13 October 2006 (UTC)

the metaphor is fine and good, but doesn't sound encyclopedic and gets kinda like 'wait, what was he talking about again?' towards the end. personally it looses me. JoeSmack Talk(p-review!) 17:22, 13 October 2006 (UTC)

I can't disagree with you there, but I'm still at a loss for how to describe it in the article in a way that doesn't violate some principle, and yet actually describes it accurately. Robert Rapplean 19:10, 15 October 2006 (UTC)

[edit] peer review/copy editing

Originally finding edge into this article via it's Peer Review request, i've finally finished and even done a good deal of copyediting along the way. Some overall comments:

  • This article needs forked articles; identification/diagnosis, effects and treatment are all too long & multifacited to not do so. I meant, this article is big, like 30k, and it gets a little tough to stick with the article when it's this daunting. It took me like a week to get through it myself for Peer Review/Copyedit.
  • More cites. It isn't usually an NPOV thing, but alcoholism is a very studied condition, and there just isn't any excuse not to have a shit-ton of sources to this baby. Someone might also look around userpages for a substance abuse counselor or something to help with these.
  • A lot of the sections seem sort of disconnected; i even caught a few repeats of something that had been said in a previous part of the article. Like a good essay, each needs to lead into each other to make a better flow.
  • Stop using that damn word 'result'. ;) Getting 'results' is one thing, but having everything 'the result of this' and 'resulting in that' makes this article seem like a robot.
  • As previously mentioned, more diagrams and images would better this article. Also, i know there is a ton of statistics out there, and it'd be great to have this article peppered in them.

Anyways, i've really enjoyed working on this baby, and i'll be around to help it out. JoeSmack Talk(p-review!) 17:55, 4 October 2006 (UTC)


Thanks, Joe. Your input has been a great help. This article tends to get smacked around a lot by POV hacks, and it's good to get unbiased input on the content.
Glad to help. :)
BTW, there's a perfectly good excuse for not having a shit-ton of statistics. The majority of these statistics are performed by someone who's trying to prove their personal theory correct, and they often conflicting with other people's statistics. Reconciling those statistics is something that's of very little interest since there's no hard evidence one way or another and no money to be made by it. Because of this, any comparison of statistics has to be done on the fly, and gets labeled "original research". Not neccessarily a good reason, but a pretty damn good excuse. I'll keep working on it.
Robert Rapplean 21:26, 4 October 2006 (UTC)
You might put a little bit in about statistics being varied, and perhaps include a range of them a demonstration of such. Again, don't worry about 'original research' interpretations so much. I think you do a great job, be bold and see where it goes. :) JoeSmack Talk(p-review!) 17:05, 5 October 2006 (UTC)

[edit] Semi-protection?

As this page seems to be a common target for vandals and we're spending half our time just reverting their nonsense, can we get it semi-protected to reduce the rate of vandalism? Nunquam Dormio 18:11, 24 October 2006 (UTC)

I second this request. Who should we talk to about this? It seems that everyone with a bone to pick wants to tell everyone that their personal annoyance is a pathetic drunk, and everyone with an idea to sell to alcoholics wants to hawk it on this page. Robert Rapplean 21:58, 31 October 2006 (UTC)

I support the idea of semi-protecting this page, at least temporarily. There has also been a problem here and on related pages with linkspammming. WP:ANI might be the place to bring it up; I'll take a look around and post a request for Sprotect. --Doc Tropics Message in a bottle 22:01, 31 October 2006 (UTC)

I posted an Sprotect request here --Doc Tropics Message in a bottle 22:13, 31 October 2006 (UTC)

  • This is getting silly. The page got vandalized multiple times...while I was requesting protection! --Doc Tropics Message in a bottle 22:50, 31 October 2006 (UTC)

Thanks, Doc. I seconded your request (dunno if that'll help or even matter), and moved it to the top of the sprotect list, where the administrators can find it. Robert Rapplean 22:58, 31 October 2006 (UTC)

Thanks RR. It was the first time I've filed a request and I automatically put it at the bottom, just like we post on Talkpages. I'm glad you caught that :) --Doc Tropics Message in a bottle 23:06, 31 October 2006 (UTC)
Seconded! Nunquam Dormio 19:00, 1 November 2006 (UTC)

[edit] Adjusting long-term physical health effects

I've had my eye on this section for a while. The article Alcohol consumption and health describes this in great detail, and it really isn't germain to alcoholism so much as extended alcohol consumption. Unless someone has a good reason not to do it, I'd like to shorten it to read as follows:


“ It is common for a person suffering from alcoholism to drink well after physical health effects start to manifest. The physical health effects associated with alcohol consumtion are described in Alcohol consumption and health, but may include cirrhosis of the liver, pancreatitis, polyneuropathy, alcoholic dementia, heart disease, increased chance of cancer, nutritional deficiencies, sexual dysfunction, and death from many sources.”

I'll let this sit for a week before taking the scissors to the article. Robert Rapplean 02:01, 2 November 2006 (UTC)

A link to the alcohol consumption article is reasonable. The vast majority of those with alcohol intake related physical disease also suffer from alcoholism, but you're right that it's the alcohol intake itself which is the cause, not the alcoholism. Drgitlow 04:42, 4 November 2006 (UTC)
Hi, sorry I'm coming so late to this discussion (my Watchlist is clogged and this got lost). I think RR's assesment is correct and the suggestion is a good one. As pointed out in the Peer Review, the article is excessively long. Whenever it's possible to streamline a section that can be linked to an independent article, we should certainly consider it. Please note, this is mostly "moral support"; I simply don't feel qualified to make decisions about specific content within those sections. --Doc Tropics Message in a bottle 20:28, 8 November 2006 (UTC)

[edit] genetic predisposition against alcoholism

i recently was leafing through a gigantic substance abuse manual, and found something pretty similar from what i see over at Effects of alcohol on the body article:

Some people, especially those of East Asian descent, have a genetic mutation in their acetaldehyde dehydrogenase gene, resulting in less potent acetaldehyde dehydrogenase. This leads to a buildup of acetaldehyde after alcohol consumption, causing the alcohol flush reaction with hangover-like symptoms such as flushing, nausea, and dizziness. These people are unable to drink much alcohol before feeling sick, and are therefore less susceptible to alcoholism. [6], [7] This adverse reaction can be artificially reproduced by drugs such as disulfiram, which are used to treat chronic alcoholism by inducing an acute sensitivity to alcohol.

i say this info should be injected into this article. what do we say? JoeSmack Talk(p-review!) 06:04, 12 November 2006 (UTC)

I'm inclined to say not. I'm aware of this particular genetic anomoly, and I'm also aware that another side effect is a slightly shorter life expectancy. My thoughts are that, while very interesting, groups who are not effected by alcoholism isn't as germain to the main topic of alcoholism as those who are and why. Also, a genetic anti-predisposition isn't very meaningful to those who are trying to understand the problem. Maybe we can start a branch with this information? Robert Rapplean 19:30, 12 November 2006 (UTC)

I'm with Rob't on this one. The genetic issue isn't relevant to alcoholism directly, but rather to metabolism of alcohol itself. It therefore would fit nicely into the alcohol article (if it isn't already there). I'm not familiar with any studies, however, demonstrating a relationship between this genetic condition and alcoholism. One might speculate, as the person making the statement above did, that individuals with this gene are less susceptible to alcoholism. I suspect that's not the case, however, and would want to see cited studies supporting such a claim before making such a suggestion. Drgitlow 22:33, 29 November 2006 (UTC)

[edit] Blossoming list of detox drugs

This is largely addressed to Dr. Gitlow because of his contributions of information regarding barbituates' value in the detox process. It's also addressed to PointlessForest, whose addition looks an aweful lot like an advertisement. Because of criticism from the recent peer review we are currently attempting to decrease the total length of the article. Creating lists of specific drugs and going into detail about their prevalance and comparative benefits is not condusive to this goal, and is kind of tangential to the general topic. Unless you're looking for a primer on how to drug someone who is going through detox, it's not very useful. I'd like to find a way of summarizing that entire section. Robert Rapplean 19:30, 12 November 2006 (UTC)

I read through this section, and I'm somewhat on the fence. There is some good info there, but from a layman's point of view I'm not sure that all the specific references add much to the article itself. Perhaps a general summary, rather than detailing the individual drugs in such depth? As Robert points out, some of them sound rather like advertising blurbs. --Doc Tropics Message in a bottle 19:40, 13 November 2006 (UTC)
There's no question that it's all too easy for an encyclopedia article about a subject to expand, especially when the topic is covered by textbooks, each hundreds of pages long. When I've made entries, I've tried to incorporate answers to questions that patients most frequently ask. Patients often ask about detox...is it safe or dangerous to do on one's own...is it painful or painless...what process is followed...and so on. There are quite a number of protocols out there, but they can be boiled down to two drug classes (barbiturates and benzodiazepines) and two intervention methods (drug challenge followed by taper; CIWA, which is a screen for withdrawal symptoms that will be repeatedly processed with the patient). Treatment is comfortable when correctly carried out and takes a few days. It is not safe to do this alone, though it is safe in an outpatient setting with proper oversight. Obviously, this brief explanation might lead to other questions: what do I mean by drug challenge, for instance, or what are the differences encountered between barbs and benzos. This is where the line might be drawn regarding the scope of the article. Drgitlow 02:08, 25 November 2006 (UTC)
Given the technical nature of the subject, a certain level of precision is required, and this further implies a certan level of necessary detail. Something that might help keep the article clean would be to write the entry as sparely as possible, while liberally linking to the important related concepts. For example, drug challenge might be an important concept, but explaining it within the article itself is sub-optimum. However, a very reasonable stub article for drug challenge could be created; it need be no more than 2 or 3 paragraphs to start. If Dr. G, or anyone else, would enter a block of relevant text, I would be happy to wikify it and add appropriate links. We could do the same for Treatment diffs of barbs and benzos, or any other important facts/concepts. This would not only streeamline the article, it would improve coverage in the med/sci articles and provide room for future expansion. I'll do the grunt-work if someone will give me the raw material to start with. Just let me know. Doc Tropics 23:38, 29 November 2006 (UTC)

I agree with Doc Tropics on this. DrGitlow's statements within his paragraph are adequate to summarize everything that people need to know on this subject. We can move the specifics to their own articles. This is central to the wiki medium. I think, though, that we need to make a firm statement about which drugs we want to list. I think we can limit it to just naming the general classes of the drugs benzoidazepine and barbituate without going into specific drug names. These should be sufficient for the reader to get an understanding of the process if linked to the appropriate pages. We have to draw a line somewhere, and that seems like a logical spot. How does that sound? Robert Rapplean 18:20, 12 December 2006 (UTC)

It sounds reasonable to me, but as always, I would defer to the consensus of our local experts : ) Doc Tropics 18:47, 12 December 2006 (UTC)

[edit] alcohol abuse costs

Im interested in more country to costs ratios, rather than just that snippet on uk, how about how much alcohol abuse costs other countries Portillo 04:31, 25 November 2006 (UTC)

[edit] Cultural and social causes of alcohol addiction

There's very little information here on the cultural and social causes of alcohol addiction. I'm not able to understand the contribution process once a topic has been closed, but the information page on alcohol addiction is pretty skimpy. It's evident that there are custodians of the topic here, but I'm not sure if this is the way to forward additional contributions.

Hoserjoe 09:06, 5 December 2006 (UTC)

Hi, Joe. The reason why there is very little on cultural and social causes is because this information is extremely subjective and as such couldn't be effectively summarized. There are a massive multitude of theories about which specific cultural elements contribute to alcoholism, but the only real consensus is that (a) alcohol availability contributes to alcoholism, and (b) attempts to limit alcohol availability only act to popularize its use. You may argue with this, and many have, but this many argue in a broad multitude of directions. This extremely broad argument makes this the subject of books, not encyclopedia articles. Robert Rapplean 18:12, 12 December 2006 (UTC)

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