3.+Alcohol+Misuse


 * Alchol Mis-use~ What is Alcholism? ** [[image:absolut_vodka_family.jpg align="left"]] [[image:are_you_an_alcoholic.gif width="232" height="332" align="left"]]

 

The following is the list of DSM-IV-TR Criteria for Substance Dependence: A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more of the following, occurring at any time in the same 12-month period):  · Tolerance o A need for markedly increased amounts of the substance to achieve intoxication or desired effect. o Markedly diminished effect with continued use of the same amount of substance. · Withdrawal o Manifested by the characteristic withdrawal syndrome for the substance in question. o<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">The same (or closely related) substance is taken in to relieve or avoid withdrawal syndromes. ·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">The substance is taken in larger amounts or over a longer period than was intended. ·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">There is a persistent desire or unsuccessful efforts to cut-down or control substance use. ·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">A great deal of time is spent in activities necessary to obtain the substance. ·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">Important social, occupational, or recreational activities are given up or reduced because of substance use. ·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">The substance use is continued despite knowledge of having persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. ·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">With psychological dependence there s evidence of tolerance or withdrawal.

DSM-IV-TR Criteria for Substance Abuse ·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following occurring within a 12-month period: o<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">Recurrent substance use is resulting in failure to fulfill major role obligations ie. At home, work, or school ·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">Recurrent substance use is occurring in situations in which it is physically hazardous ·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">Recurrent substance-related legal problems ·<span style="font-family: 'Times New Roman'; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance. (Hart, Ksir, & Ray, 2009, p.36)

WHAT IS ALCHOLISM? <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">ALCOHOLISM SUBTYPES
 * <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">Alcoholism is a chronic and progressive illness characterized by an emotional and physical dependence on alcohol. Alcoholism arises from a combination of a wide range of physical, physiological, social and genetic factors.
 * <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">Alcoholism has a direct toxic as well as sedative effects on the body. A prolonged period of excessive drinking often leads to failure to take care of nutritional and other physical needs. The central and peripheral nervous system can be permanently damaged, causing blackouts, hallucinations, and extreme tremors.
 * <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">The symptoms present when a person with BPD uses alcohol include, inappropriate mood swings, chronic anger, emptiness, boredome, anxiety, rage, depression, despair, and dissociative.

According to study by scientist at the <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;"> National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH) reveals 5 distinct alcoholism sub types. They are:


 * <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">**Young Adult subtype**: Young adult drinkers, with relatively low rates of co-occurring substance abuse and other mental disorders, a low rate of family alcoholism. Rarely seek help for their drinking.


 * <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">**Young Antisocial subtype**: More than half come from families with alcoholism, and remaining and have a psychiatric diagnosis of anti social personality disorder. They have major depression, bipolar disorder, and anxiety problems.


 * <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">**Functional subtype**: This type of alcoholism seen in middle-aged, well educated, with stable jobs and families. They have a multigenerational family history of alcoholism, major depressive illness sometime in their lives. Nearly 50 percent were smokers.


 * <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">**Intermediate Familial subtype**: Is found in middle-aged, and half of them has multigenerational family history of alcoholism. They have clinical depression and bipolar disorder. Only 25 percent ever sought treatment for their problem drinking.

<span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">. <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif;">Borderline Personality Disorder with Alcoholism
 * <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">**Chronic Severe subtype**: Comprised mostly of middle-aged individuals who had early onset of drinking and alcohol problems, Personality Disorder and criminality. 80 percent come from families with multigenerational alcoholism. They have the highest rates of other psychiatric disorders such as depression, bipolar disorder, and anxiety disorders. Two-thirds of these alcoholics seek help for their drinking problems

<span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif;"> <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">Prevelence of Alcoholism in Borderline Personality Disorder
 * <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">A study completed in Belgium found that alcoholics and those suffering from BPD often experience impaired decision-making skills, and that this impairment is increased when alcoholism and personality disorders are present at the same time
 * <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">BPD frequently co-occurs with other conditions that impact mental health. Alcholism is one disorder that is common among people with BPD
 * <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">Gabriel Rubio, associate professor at Complutense University of Madrid, Spain. ,said that around 50%of alcoholic patients have pathological impulsivity. The research indicated that “alcoholic without cluster B disorder displayed a greater inability to delay gratification than control their healthy subjects”. Alcoholic with cluster B personality disorders displayed more impairment on inhibitory control.
 * <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">People with BPD feel overwhelmed with intense emotion and use substance abuse in order to avoid or cope with painful or tense internal states .In some people with personality disorder are much detached from their feeling and feel empty inside


 * <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">There is a remarkable overlap between substance abuse and borderline personality disorders. One study found that about 60 percent of patients in psychiatric hospitals who have been diagnosed with BPD also have a co-occuring substance use problems. The most common substance use among people with BPD is alcoholism. It has been estimated that about 50 percent of people with BPD in inpatient treatment settings are also alcoholics.

<span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">Effects of Co-Occuring Alcoholism and BPD

<span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif;"> <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">Why do Alcoholism and BPD Co-Occur so Frequently?
 * <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">Unfortunately, there is also evidence that people with both BPD and alcoholism have more difficulties in their lives and are less responsive to treatment than people who have only one of the disorders. People with alcoholism and BPD are less likely to stay in substance abuse treatment, have more distress, and suicidal thoughts, and are more likely to engage in other addictive behaviours (such as binge eating or gambling) than those with alcoholism who do not also have BPD

<span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">Many of the factors that account for the high rate of co-occurence include:


 * <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">BPD and alcoholism may share common genetic pathways. Some of the genes that put people at higher risk for BPD may also create higher risk for alcoholism.


 * <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">There may be common environmental causes for alcoholism and for BPD. For example, experiences of maltreatment in childhood (such as physical or sexual abuse, or emotional abuse or neglect) have been linked to both BPD and alcoholism.

<span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 90%;">References: [|www.nlm.nih.gov/medlineplus/**alcoholism**.html]

Canwest Publishing Inc (2009). //Alcohol Use.// Retrieved November 18, 2009 from []

<span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif;"> <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 80%;">Hart, C. L., Ksir, C., & Ray, O. (2009). Drugs Society & Human Behaviour (13th edition). New York, NY: McGraw Hill Publishing.

Swartz M, Blazer D, George L, Winfield I. Estimating the prevalence of borderline personality disorder in the community. Journal of Personality Disorders, 1990; 4(3): 257-72. <span style="font-family: 'Lucida Sans Unicode','sans-serif'; font-size: 9pt;">Salters-Pedneault, K. (2009). Alcholism and borderline personality disorder. Retrieved online, October 20th, 2009 from []

Soloff PH, Lis JA, Kelly T, Cornelius J, Ulrich R. Self-mutilation and suicidal behavior in borderline personality disorder. Journal of Personality Disorders, 1994; 8(4): 257-67.

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