Dr. Shyam P Lohani

Historically, alcohol use has had an important role in social engagement and attachment. Moderate drinking or social drinking is pleasurable for many people. However, excess or heavy alcohol consumption is associated with a number of negative health outcomes. It is a risk factor for hundreds of diseases, crime, road accidents, and for many, alcohol dependence. Alcohol is linked to over 200 diseases and health conditions (WHO, 2018). Worldwide, 5.3 per cent of all deaths are linked to harmful use of alcohol which corresponds to 3 million deaths every year and as measured by disability-adjusted life years (DALYs), responsible for 5.1 per cent of the global burden of disease and injury (WHO, 2018).

Death and disability caused by alcohol start early in life. Approximately 13.5 per cent of total deaths are alcohol-attributable among the age group 20–39 years. The gender difference among alcohol-attributable deaths is significant with about 7.7 per cent of all global deaths among men compared to only 2.6 per cent of all deaths among women. In 2010, alcohol consumption per capita among male and female drinkers worldwide differs considerably with an average of 19.4 liters for males and 7.0 liters of pure alcohol for females (WHO, 20180).

Symptoms
Alcoholism or alcohol use disorder is a pattern of use associated with problems controlling drinking, being engrossed with alcohol, continuous use of alcohol despite obvious problems, need of increased amount for the same pleasure, or experiencing symptoms when halting drinking or decreasing intake. Risky alcohol use includes any alcohol use pattern that puts health or safety at risk and also includes binge drinking where a male consumes five or more drinks within two hours whereas a female at least four drinks.
Acknowledging that alcohol use pattern is a problem is a very first step in reducing problems associated with alcohol. It is important to know that treatment of alcohol use disorder is different for different people. The alcohol use disorder ranges from mild to severe and depends on a number of symptoms, therefore, treatment modality heavily relies on the stage of dependency. Many people with alcohol use disorder develop a dependence on alcohol and show withdrawal symptoms when they suddenly stop drinking. When a person stops drinking suddenly, usually within 6-24 hours after their last drink, they might develop withdrawal symptoms. This can happen also alcohol is still in the blood.

The effect of withdrawal on the body can be uneasy and oftentimes dangerous. The symptoms of alcohol withdrawal include anxiety, delirium tremens (DTs), and a life-threatening issue that can make patients restless, upset, and confused. It may cause fever, hallucinations, and seizures, depression, hallucinations, problems sleeping, shakiness, changes in blood pressure and heart rate, sweating, nausea, and vomiting.

Therefore, detoxification is the first step in the management of alcohol use disorder. Withdrawal symptoms are different for different people, mild for some but much more serious for others. Detoxification can be inpatient or outpatient. Inpatient involves detoxification at a hospital, detoxification clinic, or rehabilitation center during the treatment process. The care is available around the clock. Outpatient treatment involves treatment during the day but living at home. It is as simple as visiting your health care professional regularly for health check-ups. Inpatient offers more services but is usually costly. An outpatient is a less-expensive option that is safe and effective for people with mild or moderate alcohol withdrawal. It works best for those with stable physical and mental health, of a steady home environment with good support, and has only a short history of problem drinking.
Detox alone is not sufficient for the treatment of alcohol use disorder but it is the first step to getting better for people who are dependent on alcohol. Another approach to the treatment of alcohol use disorder is to avail the services of rehabilitation programmes.

Rehabilitation programmes can include a range of services from medical care to counseling to life skills training and help prevent a relapse. There is a chance of relapse and start drinking again even after restoring back to normal life. Therefore, it is recommended to follow-up care for at least a year. There are a lot of options, including 12-step programmes, private therapy, and group counseling. A residential rehab programme usually ranges to 1-3 months. These are good options for those having a more serious problem and struggling to stay sober.

Strategies
Preventing people from developing alcohol use disorder should be the basic philosophy of every country. Countries need to develop, implement, monitor, and evaluate policies to curtail the harmful use of alcohol. The World Health Organisation (WHO) has suggested many strategies that are effective and cost-effective. They include restricting and regulating the availability of alcohol, marketing alcoholic beverages to young people, enacting drink-drive policies, reducing demand through taxation and pricing mechanisms, raising awareness among the general public caused by harmful use of alcohol.

It also calls for ensuring support for effective alcohol policies, providing accessible and affordable treatment for people with alcohol-use disorders, and implementing screening and brief interventions programs for hazardous and harmful drinking in health services (WHO, 2018). Despite numerous strategies to prevent risky drinking, people throughout the world are exposed to risky drinking and many become addicted to its use. Therefore, the success of every treatment strategy heavily depends on the individual’s will, support from family members and the community. The first and foremost important is not to deny the problem and seek treatment as soon as possible.

(Prof. Lohani is the clinical director at Nepal Drug and Poison Information Center. lohanis@gmail.com)