Alcohol from 10,000 ft

Armin Moradi

Antisocial personality disorder and alcohol use disorder have been linked
some studies suggest that antisocial personality disorder is particularly common in men with alcohol related disorders
no causative link has been found, and other studies suggest there is no link
so, massive rock of salt
about 30-40% of people with alcohol related disorders have at some point met criteria for MDD
MDD is more likely in females, and in daily users with a family hx of alcohol use disorder
Patients with Bipolar I also have been found to be at higher risk of alcohol use disorder
the hypothesis is that they do it as a form of self-medication
Many people use alcohol for its effect in alleviating anxiety
pretty much a form of self-medication
about 25-50% of people with alcohol use disorder also meet criteria for an anxiety disorder
so spidey senses should be flying every which way to screen for anxiety disorders in someone with alcohol use disorder
Particularly phobias and panic disorders are common
interestingly, alcohol use and alcohol related disorders generally preceed development of GAD and panic disorder
causative? maybe
Suicide, ranges about somewhat approximately between 10-15%, although alcohol use itself may be involved in more
Other factors involved include living alone, unemployment, weak support, coexisting medical condition, and MDE

Genetic influences reign supreme: 3-4x higher risk in first degree relatives
risk increases with the number of alcoholic relatives and closeness of genetic composition
very wow concordance rates in identical twins
adoption studies have also found genetic link
psychological theories propose that alcohol is used to reduce tension, increase feelings of power and decrease psychological pain
as a coping strategy
interestingly, the tension reducing effects are evident at low doses
at high doses, minimal change in tension level was noted
so, it's hypothesized that this theory is actually unlikely
psychodynamic theories suggest alcohol is a way to deal with self-punitive harsh superegos and to decrease unconscious stress levels
behavioural theories suggest using alcohol is about expectations regarding the rewarding effects of drinking, cognitive attitudes toward responsibility for one's behaviour, and subsequent reinforcement after intake
the social side of things relates to cultural norms, for example jews introduce children to alcohol in a family environment in small to moderate amounts have found to be less alcoholic
but these are also stereotypes, and inaccurate at best

I'll defer the diagnostic criteria to DSM-V
But there are quite a few types and categories of alcohol dependence
Type A: late onset, few childhood risk factors, mild dependence
Type B: opposite of that
Early stage problem drinkers, affiliative drinkers, schizoid-isolated drinkers
gamma alcohol dependence (active in AA, control problems once started)
delta: must drink a certain amount each day but unaware of dependence until they must stop
Type I male limited: more psychological dependence + guilty, late onset
Type II male limited: socially-disruptive, spontaneous seeking, early stage
antisocial alcoholism: close association with antisocial PD
developmentally cumulative alcoholism: primary tendency + cultural norm
negative-affect alcoholism: mood regulation, women
developmentally limited alcoholism: binge, less frequent as ages

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