Psychiatric Consequences of Chronic Alcohol Intake; Alcohol Withdrawal; Treatment of Alcohol Use Disorders

1. Overview & Epidemiology

• Burden (Debrecen lecture, Dr. Gajdos): the average alcohol-dependent person loses 10–15 years of life span. Alcohol affects virtually every organ system and, in high doses, causes coma and death.
• Lifetime risk of dependence (Kaplan & Sadock): ~10–15% in men, 3–5% in women; ~10% of women and 20% of men meet criteria for abuse during their lifetime. ~20–30% of psychiatric patients have an alcohol use disorder.
• Onset: insidious, spanning many years. For men, typically late teens / early twenties, but rarely recognised until the late twenties/early thirties. Onset after age 45 is rare.
• Genetics: close family members have a fourfold increased risk; the identical twin of an alcoholic is at higher risk than a fraternal twin; the familial link is strongest for the son of an alcohol-dependent father.
• Personality / social picture (PSY 4.4): persons with alcohol problems make superficial social relationships easily but lack endurance in them — mirroring the lack of endurance in other areas of life. Many undergo a "change in personality," progressive isolation, lying/cheating to cover drinking.
• Subtypes: Type A/Type I (late onset, mild, little psychopathology) vs Type B/Type II (early onset, strong family history, severe psychopathology, polysubstance use).

Hungary/Europe note: Central Europe (including Hungary) has among the highest per-capita alcohol consumption and alcoholic-liver-disease mortality in the EU. Detoxification of intoxicated patients is an emergency-medicine / general-medical task; addictology (part of psychiatry) treats the sober, voluntary, cooperating patient with dependence/abuse — see PSY 2.15.