Alcohol Abuse

Alcohol Abuse: Examination of the Disease Model

Angela M. Tindall

U05a1-Etiology of Addictive Behavior DraftSHB-8811

August 13, 2014

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Dr. Leah MancusoCapella University

Table of Contents

I. Description of Alcohol Abuse

A. Symptoms of Alcohol Abuse

B. Cultural Considerations

C. Statistics Relating to Alcohol Abuse and Alcoholism

D. Current Research Findings

II. Etiology of the Disease Model

A. Description of the Disease Model

B. Philosophy of Disease Model

C. Tenets of the Disease Model

III. Cultural Implications of the Disease Model

A. Limitations of the Disease Model

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Description of Alcohol Abuse

Alcohol abuse occurs when an individual’s consumption of

alcoholic beverages leads to problems. They are not yet

classified as chemically dependent on alcohol. Social problems

that can arise from alcohol abuse may appear at work, school, or

in the home relationships, law enforcement problems, and the most

deadly, driving under the influence of alcohol (Jonas, Garbutt,

Amick, Brown, Brownley, & Council, 2012). Alcoholism is a spinoff

of alcohol abuse. It occurs when drinking alcoholic beverages

causes debilitating problems in an individual’s life. It is

characterized by physical dependence on alcohol, which normally

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leads to what is known as tolerance (Kleber, Weiss, Anton,

George, Greenfield, & Kosten, 2007).

Alcohol tolerance influences drinking behavior and drinking

ramifications in different ways. Tolerance refers to an

individual’s continued drinking, and when their usual intake of

alcohol produces a lesser affect. Therefore, the need to increase

their amount of alcohol is thus born in order to receive the

affect of intoxication (Tabakoff, Cornell, & Hoffman, 1986).

Tolerance of this nature is measured in five categories.

Functional tolerance refers to when the brain functions adapt to

counter balance for the disruption caused by alcohol in both

their behaviors and bodily functions (Chesher & Greeley, 1992).

Acute tolerance can requires an individual to consume more

alcohol. This can take place over time with consumption of more

of the substance to achieve a quicker effect (Chesher & Greeley,

1992). Environmental dependent tolerance relates to alcohol’s

effect by different drinking episodes which can be accentuated if

the alcohol is received in the same environment or is received by

the same cues (Chesher & Greeley, 1992). Learned tolerance or

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behaviorally augmented tolerance happens when an individual

practices a task under the influence of low levels of alcohol

(Chester & Greeley, 1992). Environmental independence tolerance

occurs when an individual is exposed to massive quantities of

alcohol. Finally, metabolic tolerance is attached to a group of

liver enzymes that metabolize alcohol, which is activated after a

bout of chronic drinking. In this stage, enzyme activation

increases alcohol degradation and greatly reduces the amount of

time alcohol is mobile in the individual’s body. This greatly

reduces the alcohol’s intoxication effects (Bennett, Cherek, &

Spiga, 1993).

Symptoms of Alcohol Abuse

An alcohol effects on the body interferes with an

individual’s brain communication avenues. It can affect the way

the human brain works and look. In a study by Lemke, Schutte,

Brennan, & Moos (2005) it evaluated the symptoms related to

alcohol abuse by individuals who consistently used alcohol when

they were adolescents to adulthood. Many of the participants in

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the study admitted that they experienced the following common

symptoms.

Repeatedly neglected their responsibilities at home and work

because of their drinking (Behrendt, Wittchen, Hofler, Lieb,

Low, Rehm, & Beesdo, 2008).

Using alcoholic beverages in situations that they know were

dangerous (Behrendt, Wittchen, Hofler, Lieb, Low, Rehm, &

Beesdo, 2008).

Had experiences that resulted in them being arrested for

driving under the influence or disorderly conduct in public

places (Behrendt, Wittchen, Hofler, Lieb, Low, Rehm, &

Beesdo, 2008).

Continue drinking behavior in their personal lives

(Behrendt, Wittchen, Hofler, Lieb, Low, Rehm, & Beesdo,

2008).

The use of alcoholic beverages as a means to self-medicate

or de-stress (Behrendt, Wittchen, Hofler, Lieb, Low, Rehm, &

Beesdo, 2008).

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Individuals with severe alcohol problems meet the criteria of

substance dependence as describes by the DSM IV protocol method.

People who register on the DSM IV lose control over their

drinking by consuming more and indulging in drinking behaviors

for longer periods of time than they intended to do so. They may

at some point may have a desire to quit, but cannot on their own

will. When dependence has occurred, it is known as the state of

alcoholism. Withdrawal symptoms occur when alcohol is taken away

and the body does not comprehend the absence. Symptoms of

withdrawal as described by Buu, Wang, Schroder, Kalaida, Puttler,

& Zucker (2012) include anxiety or jumpiness; the shakes or

tremors; profuse sweating; nausea and vomiting; sleep

deprivation; depression; irritability and fatigue; loss of

appetite and headaches. In severe cases of withdrawal,

hallucinations, confusion, seizures, and fevers require that

medical attention be sought.

Cultural Considerations

In a study conducted by Zapolski, Pedersen, McCarthy, &

Smith (2014) it evaluated consumption of alcohol patterns between

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African Americans and the European American Populations. The

study found that African American were less likely to report

being a user of alcohol compared to European Americans. African

American did not report binge drinking or heavy alcohol use. They

did report a higher incidence of abstaining from alcohol than

their counter parts. This may be largely due to society’s bias

views of the African American population’s crime statistics that

involved alcohol use, living in poverty, being unemployed, and

having previous educational attainment (U.S. Census Bureau,

2012).

This study also showed that African Americans today are

concerned with consequences of alcohol consumption. In previous

research articles, African American has experience financial

hardships, health problems, and problems with law enforcement

because of the consumption of alcoholic beverages (Wu, Wood,

Yang, Pan, & Blazer, 2011). In other research, the Latino

population has also been stereotyped in society as being poor and

under educated. Otiniano, Verissimo, Gee, Ford, & Iguchi (2014)

stated that Latino men have been characterized as aggressive,

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dangerous, and involved in gang related activities. Current

research has shown that Latino’s have reported higher levels of

discrimination and higher levels of discrimination and higher

levels of substance abuse. Latino men have been found to exhibit

more maladaptive coping patterns; they are more likely to turn to

alcohol and drugs due to stress related issues (Canino, Vega,

Sribney, Warner, & Alegria, 2008).

Current Statistics of Alcohol Abuse

The National Institute on Alcohol Abuse and Alcoholism

provided current statistics on alcohol abuse in the United States

by the following categories.

Prevalence of Drinking- In 2012, 87.6% of people reported

consuming some form of alcoholic beverage in their lifetime.

While 71% stated that they consumed alcohol in the past year

and 56.3 % stated that they consumed alcohol the past month.

Binge drinking was reported at 24.6% and heavy drinking at

7.1%.

Alcohol use disorders were reported for adults who ranged in

ages 18 and above were at 17 million totals. The breakdown

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was included 11.2 million (9.9%) were men and 5.7 million

(4.6%) were women. Another 1.4 million adults sought

treatment for AUD at a specialized facility in 2012.

American youth between the ages of 12 to 17 with AUD was

calculated at 855,000 adolescents, and another 76,000

received specialized treatment in a facility in 2012.

88,000 people die from alcohol related causes annually.

10,322 deaths were attributed to alcohol impaired driving

fatalities.

In 2006, alcohol abuse cost the U.S. $223.5 billion dollars,

and three quarters of those dollars were due to binge

drinking.

3.3 million Deaths were attributed to alcohol use.

Alcohol abuse was related to 200 diseases and injury

related health conditions (NIAAA, 2012).

Current Research Findings

Research findings in 2013 governing helping alcoholics quit

drinking permanently evaluated two medications that are highly

effective in treating alcoholism. The drug topiramate is

currently used to treat epilepsy and migraines. It is an 10


anticonvulsant drug that can be used to treat alcohol dependence

and the prevention of relapse (Paparrigopoulous, Tzavellas,

Karaiskos, Kourlaba, & Liappas, 2011). Topiramate acts upon the

neurobiological substrates of addiction. The drug decreases

dopamine in the nucleus accumbens in response to alcohol

ingestion, and produces a reduction in the rewarding/reinforcing

potential.

Secondly, it decreases withdrawal symptoms by stabilizing

the effect of chronic alcohol intake on the neural excitability

(Paparrigopoulous et al., 2011). The second drug that was

evaluated was nalmefene, reduces an individual’s cravings for

alcohol in heavy drinkers. It is use in patients who do not

exhibit withdrawal symptoms and who do not require immediate

detoxification. It is advised that this drug be administered only

in conjunction with continuous psychosocial support established

on treatment adherence and reduction of alcohol consumption

(Mann, Bladstrom, Torup, Gual, van den Brink, 2013).

Etiology of the Disease Model

The disease model postulates that alcohol addiction is an

irreversible and accelerating disease that is incurable, but can 11


be interrupted by abstinence. In order to specify a disease, it

must meet certain criteria. Gorski (2001) stated that a disease

is a sickness or illness that causes an interruption, cessation,

or disorder of bodily function, systems, or organs. It is thus

characterized by at least two of the following:

1. A recognized etiologic agent.

2. An identifiable group of signs and symptoms.

3. Have consistent anatomical alterations of known

body systems.

Alcohol abuse and alcoholism can be easily identifiable as a

disease due to it being a leading cause of death in the United

States. Currently, 50% of emergency room visits are individuals

seeking treatment for medical problems that are related to

alcoholism (Gorski, 2001).

Description of the Disease Model of Alcoholism

This is a biopsychosocial disease model of alcoholism. It

describes the human genetic predispositions that are present

within the influences over drinking behaviors and biologic risk

factors related to deficiencies in various neurochemicals. The

model postulates that alcohol affects the flexibility of cell 12


membranes and lipids which inevitably causes membrane dysfunction

(Wallace, 1990). Cell membrane dysfunction happens when the

membrane receives more fluid (alcohol) than normal. The cell

membrane adversely tries to adapt to the increase in fluid, but

is unable to do so, and stiffens in response, resulting in

intoxication. Therefore, stiffening of the cell membrane is

related to the biologic basis of tolerance to alcohol (Wallace,

1990).

Philosophy of Disease Model

Alcoholism has no cure and the affected individual must

somehow refrain from using alcohol. This main priority of the

model is that the addicted individual tries to pull their life

together and move toward a more meaningful and fulfilling life

without the use of alcohol. If hypothesizes that alcoholism

persists involuntarily and the cravings associated with the

condition are uncontrollable once put in motion. The model

describes an alcoholic as helpless and unable to get better on

their own abilities without the proper intervention (West, 2006).

Alcohol abusers are viewed failing one’s self, lack willpower,

and unable to exhibit self-control (Jung, 2010).13


Tenets of Disease Model

Tenets of the model include that the affected individual

accept the fact that there willpower is insufficient in

overcoming their addiction. Alcohol abusers can remain guilt free

due to the fact that their addiction is classified as a disease.

They have the opportunity to receive group treatment via

alcoholic anonymous which is an ongoing recovery tool that

promotes abstinence (West, 2006).

Cultural Implications

In treatment, one must evaluate the effectiveness of various

approaches due to their ability to affect cultural settings and

societal views on substance dependence and priorities. The goal

of treatment should include allowing the affected person to

return to normal functioning (Heath, 1986). Many cultures do not

seek assistance with alcohol abuse because alcohol use is regard

as normal. Some on the other hand do not like having others in

their personal business affairs and ultimately will build walls

to keep from being judged. Within the American Indian culture,

alcohol is viewed as normal daily activity that allows the tribal

member to commune with the higher spirits (West, 2006). 14


Therefore, it is advisable that treatment protocols be aware of

cultural practices and explains treatment opportunities to

clients prior to their startup as to keep from offending the

participant.

Limitations of the Disease Model

Research has shown that this model can persuade addicted

individuals to avoid self-responsibility in the aspect of

believing that the disease should be addressed by medical experts

verses making profound life changes. West (2006) stated that some

alcoholics oppose the concept of being labeled as an addict or

alcoholic for life. Many who have participated in such programs

as alcoholic anonymous do not like spending time with other

addicts, and do not see how being around other addicts help them

attain a fully balanced lifestyle that would help them

reintegrate back into society alcohol free.

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References

Behrendt, S. Wittchen, H., U., Hofler, R., Lieb, R., Low, N., C.,

P., Rehm, J., & Beesdo, K.

(2008). Risk and speed of transitions to first alcohol dependence symptoms in

Adolescents: A 10 year longitudinal community study in Germany.

Addiction, 103,

1638-1647.

DOI: 10.11/j.13600443.2008.02324.x

Bennett, R., H., Cherek, d., R., & Spiga, R. (1993). Acute and

chronic alcohol tolerance in

16


humans: Effects of dose and consecutive days of exposure. Alcoholism.

Clinical and

Experimental Research, 17(4), pp. 740-745.

Buu, A., Wang, w., Schroder, S., A., Kalaida, N., L., Puttler,

L., I., & Zucker, R., A. (2012).

Developmental emergence of alcohol use disorder symptoms and their potential

as

early indicators for progression to alcohol dependence in a high risk sample: A

longitudinal study from childhood to early adulthood. Journal of Abnormal

Psychology, Vol. 121(4), pp. 897-908.

DOI: 10.1037/a0024926

Canino, G., Vega, W., A., Sribner, W., M., Warner, L., A., &

Alegria, M. (2008). Social

relationships, social assimilation, and substance use disorders among adult

Latinos

in the US. Journal of Drug Issues, 38, 69-101.

17


DOI: 10.1177/00220426083800102

Chester, G., & Greeley, J. (1992). Tolerance to the effects of alcohol.

Alcohol, Drugs, and

Driving, 8(2), pp. 93-106.

Gorski, T., T. (2001). Disease model of addiction. Presented at the 10th

Annual Dual Disorder

Conference. Gorski-Cenaps web Publications. Retrieved from:

www.tgorski.com

Heath, D., B. (1998). Cultural, social, and ethnic factors, as they relate to

genetics and

alcoholism. In H. W. Goedee & D. P. Agarwal (Eds.). Progress

in Clinical and

Biological Research, Vol. 21. Genetics and Alcoholism. New

York: Alan R. Liss.

Jonas, D., E., Garbutt, J., C., Amick, H., R., Brown, J., M.,

Brownley, K., A., Council, C., L.

18

http://www.tgorski.com/


(2012). Behavioral counseling after screening for alcohol abuse misuse in

Primary

Care: a systemic Review and Meta-analysis for the U.S. Preventive Services

Task Force. Annual Internal Medicine.

Jung, J. (2010). Alcohol, other drugs, and behavior: Psychological research

Perspectives (2nd

Ed.). Thousand Oaks, CA: Sage Publications.

Kleber, H., D., Weiss, R., D., Anton, R., J., George, T., P.,

Greenfield, S., F., Kosten, T., R.

(2007). Work group on substance use disorders. American Psychiatric

Association:

Steering Committee on Practice Guidelines. Treatment of patients

with substance use

Disorders (2nd Ed.). American Journal of Psychiatry, 164, pp. 5-

123.

Lemke, S., Schutte, K., K., Brennan, P., L., & Moos, R., H.

(2005). Sequencing the lifetime

19


onset of alcohol related symptoms in older adults: Is there evidence of disease

progression? Journal of Studies on Alcohol, 66, 756-765.

Mann, K., Bladstrom, A., Torup, L., Gual, A., van de Brink, W.

(2013). Extending the treatment

options in alcohol dependence: A randomized controlled study of as-needed

nalmefene.

Biological Psychiatry, 73(8), 706.

DOI: 10.1016/j.biopsych.2012.10.020

National Institute on Alcohol Abuse and Alcoholism (NIAAA).

(2012). Alcohol facts and

statistics. Retrieved from: www.niaa.nih.gov

Otiniano-Verissimo, A., D., Gee, G., C., Ford, C., L., Iguchi, M.

(2014). Racial discrimination,

gender discrimination, and substance abuse among Latina/Latinos nationwide.

Cultural Diversity and Ethnic Minority Psychology, Vol.

20(1), pp. 43-51.

20


DOI: 10.1037/a0034674

Paparrigopoulous, T., Tzavellas, E., Karaiskos, D., Kourlaba, G.,

& Liappas, I. (2011).

Treatment of alcohol dependence with low-dose topiramate: An open-label

Controlled study. Biomed Central Psychiatry, 11: 41.

DOI: 10.11861-1471.244X-11-41

Tabakoff, B., Cornell, N., & Hoffman, P., L. (1986). Alcohol

tolerance. Annals of Emergency

Medicine, 15(9), pp. 1005-1012.

U. S. Census Bureau. (2012). Statistical abstract of the United States.

2012. Retrieved from:

http://www.census.gov/compendia/statab/2012/tables/12s0713.pdf

Wallace, J. (1990). The new disease model of alcoholism. The Western

Journal of Medicine,

152 (5), pp. 502-505.

21

http://www.census.gov/compendia/statab/2012/tables/12s0713.pdf


West, R. (2006). Theory of Addiction. Blackwell Publishing Company.

Wu, L.-T., Woody, G., E., Yang, C., Pan, J.-J., & Blazer, D., G.

(2011). Racial/Ethnic variations in substance-related disorders among

adolescents in the United States. Archives of

General Psychiatry, 68, 1176-1185.

DOI: 10.1001/archgenpsychiatry.2011.120

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