Talk:Alcoholism/Archive 7

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Guidelines for new contributors

Welcome to alcoholism! To avoid common issues that have arisen in the past, please familiarize yourself with the following commonsense guidelines:

This article is for:

• facts about alcoholism
• facts about all conditions commonly called "alcoholism"
• all sides of alcoholism (biological, social, psychological, legal, etc.)
• standard terminology related to alcoholism
• historical perspectives on alcoholism
• modern perspectives on alcoholism
• a summary of the disease theory of alcoholism

This article is not for:

• unrelated facts about alcohol
• debating the "correct" definition of alcoholism
• opinions on alcohol or alcoholics
• creating new terminology
• advertising alcohol/alcoholism related websites
• debate over the disease theory of alcoholism

Things to keep in mind:

• Please base statements on reputable sources such as published studies and books.
• Whenever possible, cite original sources rather than secondary books/articles/websites.
• "Alcoholism" means different things to different people, if you say "alcoholism" or "alcoholic" make sure the definition you are referring to is apparent.

Previous merge proposals

A vote 6-3 determined that dipsomania should not be merged (January 2009) - Dipsomania is a historical perspective, and deserves its own entry.

A vote 3-1 determined that Alcohol abuse should not be merged (March 2009) - Alcohol abuse is a symptom of alcoholism, not a synonym.

Merge from Alcohol abuse

The page Alcohol abuse needs so much cleanup that I think it is better than i am to cut our losses and merge it into Alcoholism. The page is full of POV, unreferenced statements, it is very far from comprehensive, and nowhere near resembles what an encylopedic article should look like on this topic. Fences and windows (talk) 19:25, 26 March 2009 (UTC)

• I would support oppose merging and redirecting it.--Literaturegeek | T@1k? 19:34, 26 March 2009 (UTC)

• Support - Merge and rewrite significantly. Much of the content is unsourced, dubious, and subject to deletion or extreme revision. Doc Tropics 19:37, 26 March 2009 (UTC)

• Comment - Some of the content in Alcohol abuse might be more appropriate in, or already be included within, the article on Binge drinking. Fences and windows (talk) 00:26, 27 March 2009 (UTC)

• Oppose - "Alcohol Abuse" is a separate listing in DSM-IV, so is perceived in the medical community as being different from alcohol dependence. And as we've discussed here, alcohol abuse and alcoholism are very different. One problem is that the public uses the term "alcohol abuse" in yet another way, one which refers more to quantity of alcohol imbibed rather than to a medical disease state. It's interesting that we might do better if we ignored terminology completely (which of course we can't really do in a dictionary/encyclopedia format). That is, we can all agree that there are some people who drink "too much." Of those who drink "too much," some have no obvious difficulties, some have acute difficulties, and some have chronic difficulties. There are also people who don't drink very much at all - but that group also includes people with no, acute, or chronic difficulties - but if they have difficulties they experience them intermittently rather than in an ongoing manner.

Now we could take that rubric and fit in alcohol misuse, overuse, abuse, dependence, alcoholism, heavy use, etc. But each word has different meanings to different people. Drgitlow (talk) 16:00, 27 March 2009 (UTC)

• Oppose - I'm with Dr. Gitlow on this one. One of the problems with the alcoholism page has always been that it's a vast topic, and everyone wants to put the full details of every variation and treatment into it, plus the arguments and the full histories of the arguments. Long ago we had to split off the Disease Theory of Alcoholism into its own page where (oddly enough) everyone seemed to have lost interest in the argument, possibly because it was no longer front and center as an issue on the alcoholism page. My preference, as with all subtopics, would be to have a discussion of the various forms on the alcoholism page, and then let each of the forms give more details on their own pages. Robert Rapplean (talk) 22:25, 31 March 2009 (UTC)

Discussion

Dr Gitlow has got me thinking now. He is correct, alcohol abuse refers to abuse of alcohol which includes people just going out one night a month and getting very intoxicated or going on a binge of alcohol for a few days even if it's once a month or whatever. It *might* be an idea to merge Binge drinking into alcohol abuse and do a lot of pruning of original research and uncited data. I now oppose merging into alcoholism.--Literaturegeek | T@1k? 17:12, 27 March 2009 (UTC)

Heh heh, somehow I just knew that Dr. Gitlow and I would have an initial disagrement on this topic. That's because I tend to favor expediency, while the good doctor is a stickler for technical details and accuracy. So let me say first that I'm less concerned about where this article ends up than I am with how it ends up. Reading through the article in its current condition, it's appears that several portions were written with some basis in expertise, while others were seemingly written by a process of throwing darts at a dictionary and copying the results onto this page. I would support retaining this article as a seperate title if there were sufficient (high quality) content to justify it after cleanup. However, if what we are left with is only a couple of coherent paragraphs, then a merge would still seem appropriate. Either way, it seems more and more important to do some serious housecleaning on this page. Doc Tropics 19:04, 27 March 2009 (UTC)

Hi there, Doc Tropics. It's been a while, hasn't it? I agree that some housecleaning is in order, though overall the page is better than it was several years ago. One of the issues we might want to think about at this stage, though, is the audience. My perception is that people recently diagnosed with any condition tend to then look up that condition and read everything available on the topic. If an individual is told by a clinician that he has alcoholism (or alcohol dependence or alcohol abuse), that individual will find the Wiki entry at the top of his or her google search. So in some ways, I feel we should address the needs of that audience: How is the condition defined, how is it acquired, how is it treated, and what is the prognosis. Another segment of the audience is made up of those who want historical perspective: when was it first identified, what is different about treatment now versus treatment 50 years ago, and how does the prognosis differ now versus in years past. Still another audience segment is that of the clinician...although we have the scientific literature at our fingertips, Wikipedia is even more accessible. It is rare that clinicians do not at least read through the Wiki entry for the disease or condition of current interest.

So one of the first steps would be determining which of those questions to answer. Clearly, from all the discussion we've had over the years, there are other issues that need to be addressed: Is it a disease; how does it differ from dependence, abuse, addiction, misuse, overuse, and so forth; how and why is it that there are different treatment modalities depending upon who is carrying out the treatment. We could open with that, then move on to the rest of the article using current scientific thinking as our basis for "right" versus "wrong." Or we could break each of the subsections down, answering the questions in multiple ways depending upon approach.

For example, the treatment section could say that AA represents one commonly used approach, but that there are multiple alternatives, some of which (like Rational Recovery) have been studied to some extent.

The trouble I've had in the past is that as rewrites are attempted by one or a few authors, others edit before the rewrite is complete, inevitably leading to an entry that doesn't hold together well or which has marked inconsistencies. A way around that would be for those of us who frequent this page to do our writing via email together or in an online word document, then when we're satisfied, move it over to Wiki so that it can be assessed by everyone. Drgitlow (talk) 00:50, 30 March 2009 (UTC)

With that in mind, what is alcohol abuse? The term "abuse" all by itself has such a wide range of definitions that it basically just means "any use that the speaker doesn't approve of". It could be considered "drinking to the point of health problems", but might also be considered "doing anything involving alcohol when you should be out getting a job". It's possible that this is the kind of discussion that could cover a page on alcohol abuse, but that is actually already covered on the page Drug abuse, of which alcohol abuse is a subset.

This puts me at a disadvantage because I perceive an alcohol abuse page has having about two lines. "Alcohol abuse is a form of drug abuse that involves alcohol. Alcohol abuse may or may not be related to Alcoholism." Robert Rapplean (talk) 22:25, 31 March 2009 (UTC)

Robert, that last paragraph made me laugh. It's perfect and contains all the important points about alcohol abuse. Drgitlow (talk) 22:34, 31 March 2009 (UTC)

Alrighty, we have three opposed to the merge (LitGeek, Gitlow and myself) one in favor (Tropics), one commenting (Fences). I'll give it a couple weeks for closing comments and then remove the tag. Robert Rapplean (talk) 20:18, 13 May 2009 (UTC)

Hello, I would like to suggest maybe adding a section about deaths caused by alcoholism around the world, not only in certain parts of the world. I think it would provide a clear understanding for people to realize that alcoholism is a major health problemUser: cayaa115:30, 15 May 2011Cayaa1 (talk) 10:19, 15 June 2011 (UTC)

We need to get partial protection reinstated

I requested another partial protection. If they do not grant permanent partial protection, we'll need to revisit this when it wears off. Robert Rapplean (talk) 23:16, 2 April 2009 (UTC)

Unfortunately, they decided that the IP contributions overweigh the IP vandalism, and said that we really need to keep better watch on it. If this changes, they'll reconsider. Robert Rapplean (talk) 17:53, 8 April 2009 (UTC)

Time for another go, I think. Nunquam Dormio (talk) 21:54, 4 June 2010 (UTC)

We're now protected from the kiddies until December 2010. Thanks to YellowMonkey. Nunquam Dormio (talk) 07:33, 8 June 2010 (UTC)

The semi-protection seems to have been lifted without anyone bothering to ask us. Look forward to lots of 'hilarious' edits from schoolboys. Feel free to ask to have it reinstated. Nunquam Dormio (talk) 10:12, 10 December 2010 (UTC)

Long list of health issues

Some time in the past month, someone added a huge list of health issues that long-term consumption of alcohol causes. This is a side effect of alcoholism, not something that alcoholism itself does, and it is pretty thoroughly covered under Alcohol consumption and health. It definitely does not belong in the opening section of Alcoholism. Any objections? Robert Rapplean (talk) 23:27, 2 April 2009 (UTC)

I think that was me. I did wonder at the time whether it was suitable for the lead. As it has been challenged, I have just removed it from this article and moved it to the background section of the long term effects of alcohol article.--Literaturegeek | T@1k? 11:20, 3 April 2009 (UTC)

Thanks, LitGeek. Robert Rapplean (talk) 19:25, 8 April 2009 (UTC)

Agreed, Robert. Drgitlow (talk) 19:24, 12 April 2009 (UTC)

"According to studies, over fifty percent of all suicides are associated with alcohol and drug dependence, and at least 25% of alcoholics and drug addicts committ suicide."

I think that requires a reference because I don't believe that more than 50% of suicides are alcohol related and that 25% or more of alcoholics commit suicide. —Preceding unsigned comment added by 74.13.0.69 (talk) 05:34, 16 November 2009 (UTC)

Classes of alcoholism

Do the other primary editors remember when we were discussing dividing alcoholism into multiple classes based on their root causes (psychological, neurochemical, etc.)? It turns out that we were on to something. Dr. Mark Willenbring of the NIAAA said some interesting things in a recent NYT article in that vein.

About one-third of those who develop dependence do so at about age 19 to 20. For the most part, they have a relatively mild form, and almost all get well eventually. By age 25 most of them have resolved.

About 40 percent of alcoholics have midlife onset, typically in their mid-30s. They have a relatively mild to moderate form, on average. They’re more likely to have a family history of alcohol dependence or psychiatric disorders like depression and anxiety. This is the more common pattern among women. Few of them seek any kind of help, even like talking to their minister or their doctor or psychologist. Almost none of them end up in a treatment program at this point.

And then you have the other 30 percent who have a very early onset of dependence, in their midteens. Most of them have a family history, and it’s much more common among men, and they’re much more likely to have antisocial traits. They’re the ones who are most likely to develop the relapsing form of alcoholism and end up in treatment programs.

The three divisions he discusses correspond neatly to (1) those that find social value in excessive drinking that goes away when they're moved to different social circumstances, (2) those that are driven to drink because they perceive an emotional benefit, and (3) those who drink because they have an endorphinogenic addiction.

Drawing these conclusions may not be warranted, but I'm sure we can use this to improve our article. Robert Rapplean (talk) 18:20, 7 May 2009 (UTC)

Discussion regarding new dependency section

The following text was entered by an unregistered IP address. Like most initial postings by new authors, it pushes a single view point on the issue of alcoholism, and therefore I don't feel it is either appropriate or well researched. I present it here for discussion. Robert Rapplean (talk) 17:15, 14 May 2009 (UTC)

Chronic alcoholics have formed a dependency on the product. They can’t control their yearning for it and in most cases will do almost anything to get that next sip. This is why 63.7% of Americans have had an alcoholic beverage in the past year and 48.5% have consumed alcohol in the past month (Dudley p.78-79). Alcohol is used as a way to relax your body. It finds that one switch that turns everything off leaving you just to relax and feel good. Your metabolism slows down and your mental and physical energy quickly fade. Once people know how it feels to have their body shut down and relaxed. They intentionally drink alcohol to feel that way every time they are stressed and worried because it melts all those feelings away. Most chronic alcohols only have one thing on their mind. That of is course alcohol. Everything but alcohol loses its value and even things like family and reputation are pushed aside and forgotten about. Finance is no longer an issue as long as there is still money to keep alcohol in walking distance. Alcoholics Anonymous says, “The unhappiest person in the world is the chronic alcoholic who has an insistent yearning to enjoy life as he once knew it, but cannot picture life without alcohol. He has a heartbreaking obsession that by some miracle of control he will be able to do so” (Carr p.29-30)

Carr, Allen. The Easy Way To Stop Drinking. New York: Sterling Publishing , 2005. Dudley, William. Alcohol. Farmington Hills: Greenhaven Press, 2006.

I think that this commentary by a self-help guru is simply one man's opinion. While it may be based on scientific research, the individual citations for statements such as "Most chronic alcohols [sic] only have one thing on their mind. That of is [sic]course alcohol." are lacking. I suggest that we leave it out. Perhaps it could be moved to the article on Carr.Desoto10 (talk) 22:14, 24 May 2009 (UTC)

Medications

I added a bit about the conclusions of a 2008 review of topiramate.66.120.181.218 (talk) 22:02, 24 May 2009 (UTC)Desoto10 (talk) 22:05, 24 May 2009 (UTC)

Moderate Drinking Campaigns

The author of the article "Get Your Sexy Back" is trying to de-orphan their page. Would a section on Moderate Drinking Campaigns, containing a link to that article be desireable here? If so, please contact User talk:Athenak. --James Chenery (talk) 21:08, 4 June 2009 (UTC)

Dipsomania - current or historical?

72.39.37.252 seems to have added the following text to the definitions section:

The term dipsomania is used in medical and psychiatric circles to identify a condition which is characterized by the uncontrollable craving for alcohol or other intoxicants, which manifests for unknown reasons, and can be confused with alcoholism.

I was under the impression that dipsomania was a term of historical significance only. If this is the case, this should be moved to a different section so as not to crowd and confuse currently used terms. Robert Rapplean (talk) 20:57, 12 July 2009 (UTC)

You're right, Robert. We don't use the term dipsomania in medical or psychiatric circles anymore. Drgitlow (talk) —Preceding undated comment added 12:57, 25 October 2009 (UTC).

Statistic Error

Correct statistic error... previously said 24%, reference cited stated 49%.

Seems like a good faith edit, but I checked the reference and it actually said 25.5%. --Elplatt (talk) 05:37, 23 September 2009 (UTC)

Alcohol and Crime;legal aspects?

I have seen in the media instances where alcohol abuse (drunkeness) is used as a defense when cases come before the court, and where this is an effective defense.I will research further to get accurate examples with citations as this is a controversial and important development.The implications are that if you wish to harm somebody, possibly being drunk reduces liability.Further to this is the vast resources of the alcohol industry to deny any responsibility for alcohol abuse by consumers.This is another important issue but possibly beyond the scope of this section.Ern Malleyscrub (talk) 09:24, 24 December 2009 (UTC)

Intro Creep

It looks like the latest candidate for creeping into the introduction section is the Epidemiology section. All the statistics on who has how much percentage chance of achieving alcoholism isn't actually part of the base definition of what alcoholism is, and therefore belongs in a subsection. Would anybody care to move it, or shall I do it? 17:29, 10 October 2009 (UTC)

You're welcome to move it into its own section as far as I'm concerned. I think it could also be cleaned up to replace occurrences of "alcoholism" with whatever specific criteria were used ("alcohol dependence", "dsm iv alcohol abuse", "those entering alcohol treatment programs", etc.). --Elplatt (talk) 02:36, 11 October 2009 (UTC)

Common statistical misconception

"For example, those who consume alcohol at an early age, by age 16 or younger, are at a higher risk of alcohol dependence or abuse." --This needs to be corrected. This is a common misconception of correlation. Correlation does not indicate causation. A specific reference that makes this point is Alcohol Facts and Fiction. There is also an article on wikipedia discussing this phenomenon...Correlation does not imply causation. I am deleting it from the articlePuckSR (talk) 03:02, 9 December 2009 (UTC)PuckSR

Your source is written by a professor of sociology who is employed by the alcohol industry and if I recall correctly this professor was banned from wikipedia for sockpuppeteering and disruptive COI editing. The source that you give also fails WP:MEDRS and would not be regarded as a WP:RS on this encyclopedia. You are welcome to find a recent and high quality peer reviewed secondary source for your position.--Literaturegeek | T@1k? 03:11, 9 December 2009 (UTC)

I have researched it a bit and it would seem you are correct, I shouldn't have sourced potsdam. However, I don't need a source specifically saying that people who drink before 16 are not more likely to become alcoholics. I am pointing out that this is a bit of "wrong thinking". Claiming that drinking alcohol before age 16 puts you at a higher risk of alcohol dependence is not something that should be listed as one of many "factors" that can increase your risk of alcoholism. Basically, the article as written claims that if you have a drink before age 16, you suddenly become far more likely to become an alcoholic. The two sources referenced do not support this argument. "The effects of continuous and intermittent ethanol exposure in adolesence on the aversive properties of ethanol during adulthood." was a study of showing that early exposure in mice made them less averse to ethanol later. Essentially, it proves that early exposure will make you more readily acquire a taste for alcohol. This study does not have anything to do with alcoholism. "Early-onset drug use and risk for drug dependence problems.", the other article referenced is not even a paper on alcohol. The summary of the paper makes reference to other research on alcohol, but it is not a paper on alcohol. So, as I see it, we have two articles supporting the claim that do not actually support the point being made. I would agree from a casual web-search that there are multiple sources making the claim that there is a correlation between a young drinking age and alcoholism, but I know of no study linking the causation. For example, it might be that most people who have not consumed ANY alcohol by age 16 are from cultures that do not encourage drinking, which automatically reduces the odds of them becoming alcoholics. It might also be, as the first poorly cited article mentions, that drinking at a young age makes people more likely to acquire a taste for alcohol. This would not indicate that drinking at a young age is what makes you more likely to become alcoholic, but rather liking the taste of alcohol. I just find it a horrible example of a "factor" for an addiction. PuckSR (talk) 03:21, 10 December 2009 (UTC) PuckSR

Ok, thank you for your reply. I cited two sources. The mouse study was talking about humans, then they carried out a study in mice to investigate the phenomena. I cited it for its statement in humans, I did not summarise or quote the mice findings. I will find a better source though. The other source is a 2009 review paper, it says this "There is substantial evidence that alcohol, tobacco, and cannabis dependence problems surface more quickly when use of these drugs starts before adulthood".--Literaturegeek | T@1k? 07:29, 10 December 2009 (UTC)

"There is ample evidence that the early initiation of alcohol use is a risk factor for the development of later alcohol-related problems.,,,,,,,,,,,, even after controlling for these potential explanatory factors, earlier age at drinking onset remained a strong predictor of heavy alcohol consumption in young adulthood."--Literaturegeek | T@1k? 07:45, 10 December 2009 (UTC)

I have deleted the reference which you disputed and replaced it.--Literaturegeek | T@1k? 16:18, 10 December 2009 (UTC)

Ok, I have just spent the morning improving the referencing. I can do more work if needed. Someone had misrepresented the source, the source actually said before age 14 and they are saying started drinking, they are not talking about having half a glass of wine at home once a week but are talking about getting intoxicated, at least that is how I interpret "started drinking" and context. I have found papers which discuss the reasons why early onset of alcohol use is associated increase the risk of alcoholism. Even when controlling for factors such as pre-existing risk early onset is still correlated with increased risk of alcoholism so both theories are correct in that those with a pre-existing risk typically drink earlier as well as the intake of alcohol itself at a young age directly primes the adolescent for risk of future alcoholism. Thus some people are born genetically prone to alcoholism and some people become more prone to alcoholism due to early onset of drinking by physiologically altering the genetic configuration of their brain at a young age. The mechanism believed to be behind this is an alteration in gene expression. This is not unexpected in my view because alcohol is known for causing tolerance and a physical dependence. Tolerance and physical dependence involves alterations in gene expression and promotes a dependence on the substance/drug. Neurodevelopment which starts before people are born right up through adolescent is highly susceptable to psychoactive chemicals and even life stressors determining various gene expressions, possibly permanently, thus regular drinking by adolescents alters gene expression (perhaps permanently or semi permanently) during this developmental stage to a greater degree than the adult brain.

Other major risk factors for alcoholism include inherited genetic vulnerabilities (family history) where even if a person abstains from alcohol until they are in their 30's or 40's they are still at a much greater risk than average for alcoholism. Childhood traumas and mental health also effect risk. Often there is a complex mixture of socio-environmental risk factors with genetic factors rather than one sole cause. These would be my views and I have referenced statements in the article covering these risk factors.

The study that I referenced which found early drinking age itself increased the risk of alcoholism is from Australia, rather than a country where alcohol is not widely available.

Thank you for taking the time to read MEDRS and RS wiki resources. I have sent you a welcome message which gives additional links to help you with how to contribute to the encyclopedia. I dunno if you have refs for your viewpoint?--Literaturegeek | T@1k? 15:51, 10 December 2009 (UTC)

See also this new section that I created and referenced.Alcoholism#Risk_factors--Literaturegeek | T@1k? 16:18, 10 December 2009 (UTC)

As much as I appreciate your work, I think perhaps the original reference should still be changed. You referenced multiple factors which can contribute to alcoholism. A genetic pre-disposition is probably a much better example of a contributing factor than a statistical correlation. The causation of genetics is indisputable, while the causation of a correlation is obviously disputable. It just makes sense to me that any listed "example" for something should typically be the best example available. It doesn't change the information presented on alcoholism, but does remove any question. My entire argument isn't based on the validity of data to back up the example, but rather on the quintessential nature of the example.PuckSR (talk) 03:42, 11 December 2009 (UTC)

Well a genetic contribution to alcoholism would be determined by statistics, eg how many alcoholics have a family history versus those that don't have a family history etc. It can equally be stated that the developing brain is more sensitive to chemical "insults" than an adult brain is indisputable. I think the problem here is the refs say something and in your personal opinion don't agree with it and want it changed. This is quite a common reason for content disputes, see this essay WP:JUSTDONTLIKEIT.--Literaturegeek | T@1k? 02:33, 12 December 2009 (UTC)

I apologize for changing the article again without a response, but I am not fully familiar with the methodology of editing. I once again stress that I don't object to the studies which point to a correlation between age of first drink and alcoholism, rather I object to its use as a quintessential "factor". Other factors have been linked, many of which seem to be a better example. A section referencing all of them seems to be a wonderful idea, but mentioning the age link in the opening seems a bit troublesome. e.g. there is also evidence that people who have issues with fear and phobias are more likely to have alcohol dependencies. It is an interesting correlation, but I wouldn't list it as my example of a factor. I make this comment because there seems to be some issue with the age/alcoholism connection. Mainly, that at least one study I looked at indicated that there is a less significant correlation between those who drink before the age of 11.[1] This would seem to indicate to me that the link is not simple, nor fully understood. Also, I did not find an article that explained the link, but merely commented on a known correlation

I would argue, that from a scientific perspective, a claim that something is a "factor" would indicate that the link is understood. As another example, there is a significant correlation between rates of AIDS infections and selenium levels in local soils selenium. This is not listed as a factor in susceptibility to AIDS infections. There are studies which indicate a link, but since the link(statistical correlation) is not understood...it is not considered a factor.PuckSR (talk) 23:43, 11 December 2009 (UTC)

I don't think that there are better examples per se in as far as what we are talking about now. The 2009 study controlled for inherited traits and still found correlation between early onset of alcohol drinking with increased risk of alcoholism. That means that correlation and causation has been demonstrated. Sure there are always the possibility that future studies will find contradictory views. If you are aware of such studies you are welcome to cite them. Do you have a source which agrees with your position? If you don't then it constitutes original research/personal opinion which cannot be used to write an wikipedia encyclopedia article. You are indeed correct that mental health conditions (you gave examples of anxiety states) increase the rate of alcohol abuse and this is cited in the lead section "mental health".

I read the paper, those aged between 11 and 14 were 10 times more likely to develop alcohol dependence than those who delayed alcohol use until 18 -19. The statistics were based on time since first drink to developing alcoholism.

I don't find it surprising that there was a greater time delay from those who had their first drink at age 10 years or younger developing alcoholism. Who is going to regularly buy 8, 9, 10, 11, 12 year olds alcohol so they can become alcoholics? How are they going to afford it? They probably had their first drink by stealing a bit of whisky out of the cupboard and drinking it with their friends in small quantities I would imagine. Anyway, I dunno if you looked at the chart but if you look, those who had their first drink when aged under 11 showed basically the same risk of becoming alcoholics as those who had their first drink between age 11 and 14. Yes there was a time delay, i.e. it took more years from first drink to become alcoholic but like I say, how many 11, 12, 13 year olds can become alcoholic even if they wanted to, money, opportunity, availability of regular supply of alcohol etc? Anyway I am drifting into original research but the source is not saying that children who first drink under age 11 are not at risk of alcoholism, the opposite is true, they do become alcoholics much much more often than those who delay alcohol use until age 18-19.

Ok, so my point is yes the paper raised an anomaly with results froom 11-14 and those who had first drink when aged under 11 but it is not saying that it is as "safe" or "no increased risk" in terms of future risk of alcoholism for 10 years or younger to drink alcohol, nor is it saying that about those aged 11-14.--Literaturegeek | T@1k? 02:43, 12 December 2009 (UTC)

Let me explain my reasoning once again. There is definite evidence of a correlation, but there is still no concrete evidence of causation(i.e. a study of chemical reactions in adolescents). I am not arguing that there is not significant evidence to support this as a potential factor, but for clarification of the article. The correlation is listed elsewhere in the article as a factor. Genetic predisposition is a much more solidly understood factor. If a factor is going to be mentioned in the opening of the article, I believe the quintessential factor should be mentioned.17:58, 12 December 2009 (UTC)

I am not familar with selenium and aids and do not know the literature on this issue, sounds strange to me though but we are comparing apples and oranges here.--Literaturegeek | T@1k? 02:33, 12 December 2009 (UTC)

My point is that the studies have all be statistical studies. We have not conducted a controlled study, where adolescents were given alcohol. I am not advocating such a study, but explaining that it would be more solid evidence of a causation. Please read Correlation does not imply causation. The studies cited have all controlled for genetic predisposition, but nothing else. I imagine that a number of factors contribute to alcoholism(as you yourself have argued) and until a study has controlled for all of the known factors. I don't mind having this listed as a factor, since I have no study. However, I can see how this is not a completely proven factor. I just don't feel comfortable placing a questionable factor when a much better factor is already listed. It also seems that listing two factors as examples of factors is just silly. We clearly have an entire section of the article dedicated to discussing factors. It might even be argued that none need be listed(since I imagine most people understand the concept of a factor), but I imagine you wouldn't tolerate that.PuckSR (talk) 17:58, 12 December 2009 (UTC)

I am familar with correlation not necessarily meaning causation. The article does not give definitive causation, see bold text of quotes from this wiki article. "Alcohol abuse during adolescence may lead", "are associated", "may itself directly influence", "may be due to the highly sensitive developing adolescent brain"; where in this article have I used the english language to imply definitive cast iron causation? It is worded infact as associated or appears to be etc which is what the sources say. There is more than two factors listed; there are multiple factors mentioned now and I just summarised the citations. What we do on wikipedia is just summarise the current state of knowledge, using uptodate sources and preferably when possible secondary sources per WP:MEDRS and stick closely to what sources say. I feel that I have done this but can improve sourcing if you like and expand on risk factors section. I am unconvinced that early recreational alcohol use/misuse has no risk in increasing alcoholism risk and I have seen no sources which back up your viewpoint. I feel that I am accurately reflecting the current state of knowledge in this area.--Literaturegeek | T@1k? 18:13, 12 December 2009 (UTC)

A bit of clarification is necessary. I have been making these posts with very limited time to fully review the comments that literaturegeek was making. I believe there is a basic disagreement between the two of us over the term "factor". As you yourself said, the current scientific thinking is that drinking at an early age encourages expression of a genetic predisposition to alcoholism. In other words, someone who is NOT genetically predisposed to alcoholism will not be any more likely to become an alcoholic from drinking at an earlier age. The abuse of statistical correlation is that it is being claimed that drinking alcohol at an early age makes you more likely(twice as likely) to become dependent on alcohol. This is flawed. First, one would only be more likely if they had a genetic predisposition. The study being referenced actually SPECIFICALLY states that the reason for early drinking may be an expression of the same gene that makes people prone to alcohol addiction. In other words, there is correlation, but not causation. The drinking may be due to a predisposition rather than causing a predispositionPuckSR (talk) 23:31, 12 December 2009 (UTC)

That is not what I was saying at all. I was saying the opposite. I was saying that someone who was NOT predisposed to alcoholism will or can make themselves predisposed by starting drinking at an early age by altering gene expression. Everyone is prone to altering gene expression at an early age due to chemical "assaults" or traumatic events. Your life events will have shaped your gene expression from feotus to adulthood and even as an adult gene expression can change but not as easily and profoundly as when one is younger. Genetic predisposition is not the best wording, gene expression, so like I assume what they are saying is that changes in either the dopaminergic reward pathway get altered or GABAa receptor function down regulates (as a result of tolerance) as a result of the young brain being exposed to alcohol in high enough quantities regularly enough. Are you familar with drug tolerance and the neuroscience behind it? You are mixing up what born genetic predisposition, i.e. what is in a person's DNA, i.e. what they are born to be and changes in gene expression caused by life events and chemical exposures when young or in a developmental stage.--Literaturegeek | T@1k? 02:32, 13 December 2009 (UTC)

Also, could you please indicate which study being cited specifically states that "half of those who begin drinking alcohol before age 14, develop alcohol dependence before the age of 21". That claim seems to be an incredibly high number and I didn't notice that specific number referenced in any of the cited sources.PuckSR (talk) 23:31, 12 December 2009 (UTC)

The source said that it was just under half or words to that effect. It is the results of a large scale epidemiology study in the USA which I can cite directly to if you like. It is currently cited to the New York times. Tell you what, would you be happy if the statement was moved from the lead to the risk factors section? Like I mean give it less prominance in the article. I could compromise with you on that as it is not a secondary source.--Literaturegeek | T@1k? 02:32, 13 December 2009 (UTC)

I would be happy, but I would still like to know which source we are discussing about the 50% figure...since I cannot find it. I am particularly worried about citing "half", since I found multiple news articles that claimed 50% of young people drink before the age of 14 in some countriesThe Independent article. If we consider both of those claims to be true, then it should be expected that almost 25% of British people are alcoholics. I don't think you are lying, but since I cannot find the statement of "nearly half" I want to make sure I am checking the correct article.PuckSR (talk) 02:58, 13 December 2009 (UTC)

It was the new york times, but I have now changed the reference to cite directly the longitudinal epidemiology study. It was not myself who added the new york times reference or quoted it. The actual figure was 40 percent. See risk factors section. Yes alcohol abuse in young teenagers is very high in recent years but I do not see how you are calculating the 25 percent statistic from. The first problem with your original research of stats in the independent source is that we can't say anything until 50 - 70 years from now as we have to wait until those adolescents grow up and die and then get statistics to calculate a life time risk of ever having an alcohol dependence. You are again not understanding the sources, by saying "are alcoholics", it is life time risk of ever having alcohol dependence/alcoholism, many people have become alcohol dependent for more than 6 months and then quit drinking. You seem to be applying the statistics to only people who become permanent active alcoholics, who hit the bottle and die by the bottle, never being able to quit. The sources do not restrict their statistics to chronic alcoholics but it is of "ever alcoholic/alcohol dependent" i.e. life time risk.--Literaturegeek | T@1k? 11:43, 14 December 2009 (UTC)

when you say you have cited the 'long term epidemiology study' I couldn't help but raise an eyebrow - that must be some study!!! Cross sectional studies must be treated with a pinch of salt and longitudinal ones must be treated in a similar way as they tend to run out of steam, interest or money usually. I have seen a lot of things discussed trying to sort of 'pin it down' when that's probably not the case and suspect that's there other temperance factors at work alsoThetiesthatbind (talk) 00:37, 7 March 2011 (UTC)thetiesthatbind

Article Direction

I have concerns that the article is still going in the wrong direction. We open, for instance, with the sentence indicating that there are multiple conflicting definitions. That's true for almost everything, but encyclopedic articles generally open with the accepted definition. For alcoholism, that would be the consensus definition printed in JAMA several years ago (ref #7 in the wiki article). Like schizophrenia, diabetes, and hypertension, there are many perspectives about alcoholism, but from a medical standpoint there is one broad consensus and evidence-based definition. That should be the opening of the article. We can certainly describe non-scientific or minority perspectives at another point in the article. As with other medical conditions, we should open with the definition, then go to the epidemiology, being certain not to confuse alcoholism, the addictive disease state, with alcohol use. Alcohol use causes morbidity and mortality separate from the morbidity and mortality caused by alcoholism. After epidemiology, we can describe treatment approaches and finally prognosis. Historical background and alternative perspectives can be addressed at the end. At least that would be my approach to the topic. Drgitlow (talk) 14:51, 21 March 2010 (UTC)

Agreed. Discussions of classification and definition should be done in the article body, not the introduction. Use schizophrenia, diabetes, hypertension and others as a guide. I suggest you go ahead and reorganize the article so we can see what you mean. -kslays (talk • contribs) 00:17, 22 March 2010 (UTC)

Thank you DrGitlow. You are right that the article should give most WP:WEIGHT to its mainstream definition and less weight and emphasis to the minority views. I agree that minority views should not be included in the lead of the article and are better discussed briefly in another section of the article. To echo what Kslays has said I would encourage you to get involved and WP:BOLDly edit the page, perhaps you could start by creating a prognosis section. As I am hoping to get this to a good article status, we need to be mindful of WP:MEDRS, i.e. good sourcing such as secondary sources (review papers, meta-analsyis or text books) published within the past 10 years, preferably the past 5 years. I have stripped down and rewritten the lead section. I intend to rebuild the lead section by summarising important points from the main body of the article.--Literaturegeek | T@1k? 12:17, 22 March 2010 (UTC)

Literaturegeek, you are making the mistake of thinking that Wikipedia is a dictionary. A dictionary needs to identify the primary definition of things and list it first. An encyclopedia, on the other hand, needs to relate the facts regarding the concept that the word embodies. This is about explaining concepts, not about defining words.

The primary reason that the opening paragraph stated that there are multiple definitions is because there is no single strongest opinion about what alcoholism is. JAMA and the DSM disagree about what exactly you're talking about, and AA has a completely different opinion. If you want to talk about the MAINSTREAM opinion, then you have to describe it the AA way because that's what most people think when they hear the word.

By taking the JAMA definition as the primary definition, you are violating WP:WEIGHT by introducing bias towards a specific viewpoint. This is an old argument that is akin to religion, and you've just decided to back the Church of JAMA.

Via studies of drinking trajectories, the NIAAA has relatively recently determined that the bulk of drinkers fall into three categories: the early adult drinkers, the chronic heavy drinkers, and the late-onset heavy drinkers. The second two of these are populated by people who have a problem, know they have a problem, and don't know what to do with it. They fit the "disease" model of alcoholism. The first group, however, is largely populated by people who don't think they have a problem. Since it's a behavioral issue and not a biological malady, this means it is not a disease any more than poor time management skills is a disease. It's an unfortunate social choice with possible nasty long-term consequences.

The point is that NIAAA recognizes all three of these as alcoholism. By going with the JAMA definition, you are encouraging the readers to misdiagnose the majority of the young adult drinkers. In short, the first paragraph is guilty of pigeon-holing them, attempting to force round pegs into square holes.

The problem with the Alcoholism page is, and always has been, that the term Alcoholism refers to a symptom -- a behavior change -- not an actual malady. JAMA's definition is similar to a statement that all headaches are caused by viruses and bacteria, whereas the DSM's insists that they're caused by banging your head against walls, and AA insists that they're caused by demons trying to take over your mind. While I agree that some definitions should have more weight than others, I don't believe that the JAMA definition deserves the primacy that you've granted it. Robert Rapplean (talk) 16:56, 17 April 2010 (UTC)

Stereotactic surgery

Researchers in China (Department of Neurosurgery and Institute for Functional Brain Disorders, Tangdu Hospital, The Fourth Military Medical University, Xi’an) are using stereotactic surgery for treating alcohol dependence by ablating the nucleus accumbens, a part of the brain's reward system. There is a need to mention this somewhere, not because it is good form of treatment but a potentially abusive one. see Wu HM, Wang XL, Chang CW, Li N, Gao L, Geng N, Ma JH, Zhao W, Gao GD. (2010). Preliminary findings in ablating the nucleus accumbens using stereotactic surgery for alleviating psychological dependence on alcohol. Neurosci Lett. 473: 77–81 doi:10.1016/j.neulet.2010.02.019 PMID 20156524--LittleHow (talk) 10:43, 22 March 2010 (UTC)

Gender and alcoholism

After another look at this section, I think it would be better split up and distributed into other sections where appropriate, e.g. symptoms / epidemiology / prognosis etc. Lee∴V (talk • contribs) 01:15, 30 March 2010 (UTC)

Hmmm, I am not so sure Leevan, the section (and its subsections) make up quite a bit of text. Would it not crowd the other sections? If you have a vision of how to work it into the other sections feel welcome to merge the content though.--Literaturegeek | T@1k? 00:17, 31 March 2010 (UTC)

Related articles

Both Alcohol dependence and Alcohol abuse state that they are 'sometimes referred to as the more general term alcoholism', I wonder if they might be merged, or at least rationalized as a sort of disambiguation here ... Lee∴V (talk • contribs) 01:13, 2 April 2010 (UTC)

Well spotted Lee. Alcohol dependence is alcoholism so it should be merged into this article. If you see this section above it was discussed Talk:Alcoholism#Merge_from_Alcohol_abuse and agreed that alcohol abuse is not the same as alcoholism as it is a broad term which includes binge drinking eg getting very drunk once a week or once a month etc.--Literaturegeek | T@1k? 12:46, 3 April 2010 (UTC)

I have merged alcohol dependence into alcoholism. There was not much worth saving from it as it was mostly poorly cited or uncited.--Literaturegeek | T@1k? 13:02, 3 April 2010 (UTC)

Change Risk factors to 'causes'

Notepad thought Risk factors didn't seem quite right, checking Wikipedia:MEDMOS#Sections 'risk factors' is one of the suggested contents of 'causes', mind if we change this section's heading? Lee∴V (talk • contribs) 18:49, 13 April 2010 (UTC)

I am happy with the section being renamed to causes.--Literaturegeek | T@1k? 18:52, 13 April 2010 (UTC)

Working notes

Some notes as I attempt to concentrate on commas etc. first .. Lee∴V (talk • contribs) 23:51, 14 April 2010 (UTC)

• Terminology: Currently we have various terms referring to people dependent on alcohol, I feel we should stick to one term. This led me to the feeling that the term 'alcoholic' is inappropriate, we can say 'commonly known as alcoholics' but should probably use something more neutral ( that could be used for any drug). Not sure what term to use but how about 'alcohol dependent' or 'person dependent on alcohol' or simply 'alcohol addict'?
  • Also the term alcoholism - 'alcohol dependency/addiction' ?

• Signs and symptoms:
  • a lot of the parts about suicide ought to be moved to prognosis. ( these are repeated in more than one sections ). ((done-t}}
  • social effects: ought to be in society and ethics ?  Done
  • some of signs and symptoms would be better in a 'mechanism' section or such.  Done
  • Alcohol withdrawal: important to state but maybe summarize and move section to 'management'

The terminology stuff about "use" and "abuse" and so forth, I would be tempted to trim or even just delete it. I am not sure it is of benefit to the article.

With regard to signs and symptoms, I agree with your first point. The second point, I am not sure about "ethics", it doesn't fit the section better, I don't feel. Yes some content could be moved to a "mechanism" section, but I think pathophysiology would be a more appropriate and more descriptive choice than mechanism. Yes I agree with moving alcohol withdrawal to management section.

Thanks for your suggestions. I would start to implement some of them but I am getting that tired feeling, ugh. :)--Literaturegeek | T@1k? 00:23, 15 April 2010 (UTC)

I'm not surprised, it's a tricky article - but thanks to your hard work I think it's past the tipping point now... Not all my thoughts are , well thought out, I just chuck them out whilst in the middle of other things in case they are good and slip away into the eather. I agree with your idea on the page move... here's another before the matchsticks holding my eyelids break...

• Move the various sections of 'gender' into their relevant sections in the rest of the article ( causes/mechanism/treatment/epidemiology) - I've moved race but have to have another look since some of it needs to go into epidemiology. rest well ! Lee∴V (talk • contribs) 00:51, 15 April 2010 (UTC)

'tis  Done Lee∴V (talk • contribs) 12:57, 20 April 2010 (UTC)

Brilliant work Lee. The gender section was "out of place", looks much better now. Another nice improvement! :)--Literaturegeek | T@1k? 00:54, 24 April 2010 (UTC)

Agreed, great work integrating the gender information. I was actually a bit sad to see it go because the differential effects of alcoholism and gender is one of my principal areas of research, but it does make more sense for it to be integrated. I'll try to get around to adding more info about the group*gender interactions (after my quals, or as soon as we publish... ;). -kslays (talk • contribs) 14:13, 24 April 2010 (UTC)

Thanks, but you guys with the refs and info are the key! It should help for the flow of the article and once it is solid it looks to me that there are enough differences in gender and alcohol use/metabollism/symptoms to warrant a separate article that can cover the subject in a more focused way. --Lee∴V (talk • contribs) 22:27, 25 April 2010 (UTC)

Have moved fatal symptoms into prognosis, feel this needs some work to tally with management - i.e. prognosis for breaking dependence and for untreated condition.Lee∴V (talk • contribs) 22:59, 26 April 2010 (UTC)

Alcoholism and alcohol dependence

For most other substance addictions, it is referred to as dependence, such as cocaine dependence, benzo dependence, nicotine dependence, opiate dependence and so forth. It is referenced in the article that the World Health Organisation prefers to use the term "alcohol dependence" syndromes rather than alcoholism. So this raises the question of whether we should rename via moving the article to "alcohol dependence"? I think alcohol dependence is a better scientific discription. Alcoholism while still widely used both by lay people and professionals and professional bodies is a little bit outdated but I suspect that renaming the article may generate some controversy and differences of opinions, but perhaps not. I would support a move to alcohol dependence and in the lead sentence say "also referred to as alcoholism" or words to that effect.Literaturegeek | T@1k? 00:23, 15 April 2010 (UTC)

Oppose renaming. I think we should stick with the commonly used term that people will type in their search engines. If we rename, then this article will fall down the list of search results and people are more likely to visit sites set up by commercial concerns, quacks, and lobbyists. The article should perhaps state that professionals may prefer "alcohol dependence" as a term. Nunquam Dormio (talk) 09:42, 15 April 2010 (UTC)

Interesting point - I am kind of against tailoring articles to meet googles needs, but I see your point. I wonder if it would still turn up high even with a different name ... investigation required..Lee∴V (talk • contribs) 00:17, 16 April 2010 (UTC)

I also oppose renaming. Even in the literature where the DSM (which separates abuse, dependence, and withdrawal) is king, many people use the term alcoholism. I think a discussion of differing definitions, characteristics, and nomenclature is an essential part of the article. -kslays (talk • contribs) 17:13, 15 April 2010 (UTC)

Kslays,Nunquam, I see you are opposed to renaming of the article, but what are your views of dropping the terminology in it's content - with an obvious pointer in first line e.g. 'termed alcohol dependence by professional bodies' and using that term throughout rest of article? Lee∴V (talk • contribs) 00:17, 16 April 2010 (UTC)

(outdent) It looks like there is no consensus for a move

The term "alcoholism" encompasses both alcohol abuse and alcohol dependence. --Arcadian (talk) 01:58, 16 April 2010 (UTC)

Yes Arcadian, alcoholism is a form/type of alcohol abuse, but alcoholism is not the definition of alcohol abuse (if that makes sense), I shall explain. There was at one point a discussion (see above) and a vote on whether to merge alcohol abuse into alcoholism. The vote opposed the suggested move because alcoholism is just one type of alcohol abuse. Going out one time a year (say new years eve) and getting very drunk is alcohol abuse. Binge drinking once a month for a few days is alcohol abuse. Underage teenagers getting very drunk say a couple of times a month is alcohol abuse. None of these types of abuse are alcoholism. Alcoholism itself is obviously alcohol abuse as well. Alcohol abuse covers several problematic/harmful drinking patterns.--Literaturegeek | T@1k? 22:51, 16 April 2010 (UTC)

I strongly support Literaturegeek's proposal to move the article to "alcohol dependence" (with a rearrangement of the content to address the different ways in which the term "alcoholism" has been used). However, if this article stays at "alcoholism", then I oppose merging "alcohol dependence" into "alcoholism", because the former term can be more precisely defined, even if the content at that page is currently not well developed. --Arcadian (talk) 23:48, 16 April 2010 (UTC)

(outdent} Nunquam Dormio, I understand your concerns but I don't think this article being renamed/moved to alcohol dependence would result in any drop in search engine ratings due to the very large volume of wiki links and links from external websites containing the keyword alcoholism. Also we could use alcoholism interchangably in the article as a compromise. As a demonstration, I would suggest typing "xanax" into google and seeing what comes up first and then typing in "alprazolam". You should find that both rank in first place, despite the article being called alprazolam. This is due to heavy linking to a popular topic with links on wiki and off wiki containing the term xanax. :) Fear not.--Literaturegeek | T@1k? 00:38, 17 April 2010 (UTC)

• I'm not sure that we can pick the One True™ definition. For example, LG says that binge drinking is not alcohol dependence, and it's true that a person who spends the weekend in a drunken stupor might not always be an "alcoholic" according to a researcher -- but that's almost certainly the term that the family, friends, and support groups will use to describe him. We might need to expand the Classification section slightly. WhatamIdoing (talk) 01:49, 17 April 2010 (UTC)

It is a tricky one for sure WAID. I feel that we do need to choose which definition is best because we currently have two articles for the same condition, alcohol dependence and alcoholism.--Literaturegeek | T@1k? 03:11, 17 April 2010 (UTC)

• I say we use alcoholism as this is the most recognized term and than carefully define both this and alcohol dependence in a classification section as WAID recommends above.Doc James (talk · contribs · email) 02:00, 17 April 2010 (UTC)

If we go with alcoholism Doc, what do you feel should be done with the alcohol dependence article? I had previously redirected it here but Arcadian undid my redirect as he feels that alcoholism should redirect to alcohol dependence.--Literaturegeek | T@1k? 03:11, 17 April 2010 (UTC)

Thanks for the comments.--Literaturegeek | T@1k? 03:11, 17 April 2010 (UTC)

IMO the two are sufficiently similar that they should be dealt with on one page rather then on two pages. Thus I agree that alcohol dependence should be redirected to alcoholism.Doc James (talk · contribs · email) 15:03, 17 April 2010 (UTC)

I agree and I think there is a consensus that there should only be one page. The problem is that it seems that there is a hung jury here with half of people wanting the article to be alcohol dependence and the other half alcoholism. Is there wikipedia policy or guidance for naming medical articles? Maybe we are going to need to use policy and guidance to decide this one.--Literaturegeek | T@1k? 15:26, 17 April 2010 (UTC)

Sure, MEDMOS addresses it. However, I don't think that this is a purely "medical" subject, so imposing "medical researcher terminology" on it (although IMO acceptable) might not actually be the best choice. There are significant social issues here as well. WhatamIdoing (talk) 17:10, 17 April 2010 (UTC)

Hmmm, you have a point although I still do favour alcohol dependence; I think that maybe the best thing to do is wrap this up as no concensus for renaming.--Literaturegeek | T@1k? 17:45, 17 April 2010 (UTC)

Perhaps I can be of some help here. "Alcohol dependence" is a psychiatric term described in the DSM. Unfortunately, it is also a medical term that refers to the decrease in GABA production that results from heavy consumption of alcohol. In medical terminology, alcohol dependence is what is addressed during detox, and is what results in delirium tremens and possible death during alcohol withdrawal. If you do rename this page to alcohol dependence, you would need to create a differentiation page that also points to the condition that results in withdrawal.

As a further point, changing the name to Alcohol dependence would lock you into the psychiatric definition of alcoholism, which would require you to move the content for the JAMA definition to a different page. Since JAMA does refer to it as alcoholism, then the different page would be called "Alcoholism", which leaves you in exactly the pickle you're currently in.

In general, I would be happy with the elimination of the term Alcoholism. Unfortunately, none of the existing terms is an adequate replacement. I believe it is the best word we have to describe the concept, so I will vote against it. Alcohol dependence is a sub-set of alcoholism. Robert Rapplean (talk) 17:21, 17 April 2010 (UTC)

Me, again. After perusing the current state of the article, I would like to nominate Alcohol dependence syndrome as the new name for the article. I believe that has three things going for it. (1) It's the new international standard, (2) it's different enough from alcohol dependence that you don't need differentiation, and (3) it isn't tied to any single school of medicine. Robert Rapplean (talk) 17:29, 17 April 2010 (UTC)

Thanks for your views Robert, although I do not quite agree. Alcohol dependence is not a subset of alcoholism, it is alcoholism; they are the same. Alcohol dependence covers both physical dependence and psychological dependence, as does alcoholism. Two different names for the same condition. Alcohol dependence I believe is more commonly used than alcohol dependence syndrome.--Literaturegeek | T@1k? 17:45, 17 April 2010 (UTC)

The problem with this perspective is that alcoholism most pointedly does NOT refer to physical alcohol dependence. They are distinct concepts. You can cure a person of physical alcohol dependence by putting them through detox. This re-balances the GABA production. This absolutely, positively does not cure them of alcoholism. They still suffer from the psychological urge to drink and, should they succumb to that urge, they have a well documented inability to stop drinking. Detox is generally considered a first step towards treating alcoholism, something that gets the actual drinking out of the way so that the core problem can be addressed. Robert Rapplean (talk) 19:38, 17 April 2010 (UTC)

Alcoholism includes both physical dependence and psychological dependence. I am talking about the medical/scientific definition. Perhaps you are referring to a philosophy in a local support group like AA? See this link. A physical dependence is a widely recognized feature of alcoholism as is psychological dependence. Of course this can vary from individual to individual, one person may present with stronger physical dependence and others with a stronger psychological dependence but both are usually present to varying degrees and make up the syndrome/disorder/disease known as alcoholism/alcohol dependence.--Literaturegeek | T@1k? 20:00, 17 April 2010 (UTC)

This is actually from the understanding gathered from a few years of discussion on this page, and a serious examination of the available information. The four main features listed in the link to the NIH that you provides is actually a description of symptoms that are used to determine alcoholism, not a definition of what alcoholism actually is. For instance, measles is described as having symptoms of an itchy skin rash, fever, cough, runny nose, and conjunctivitis (pink eye). This doesn't mean that any of them are inherent to the condition. Similarly, while physical dependence is a symptom of alcoholism, it can be achieved without alcoholism actually being present. In fact, physical dependence occurs regularly during any normal bout of heavy drinking - that's what a hangover is all about.

If you examine the studies involving treatments for alcoholism, they standard measure for effectiveness is "time until relapse" or "time until first drink". They all presume that the drinker has stopped drinking and completed detox before the treatment starts. Physical dependence has been entirely removed from the picture, and yet the person is still considered to be an alcoholic.

I'm concerned that you harbor the common misconception that alcoholism is just uncontrolled heavy drinking. Such a perception could seriously damage the content on this page. Long ago, we determined that alcoholism is pretty much anything that prevents a person from not drinking when they know they shouldn't, and that includes numerous things. Please take advice from the other participants of this discussion page before continuing in that vein. Robert Rapplean (talk) 18:15, 19 April 2010 (UTC)

Your comparison with measels is done unfairly. Physical dependence is not a symptom like fever rash etc. A more fair comparison would be to compare, craving, DT's, anxiety, insomnia, agitation with the symptoms of measels fever, cough etc.

I am not sure you understand what a physical dependence is. A hangover is not the result of a physical dependence but rather to the toxic effects of alcohol and the production of excess acetylaldehyde, which produces nausea, vomiting and headache etc.

Alcoholism is no longer used diagnostically by WHO or DSM, it is an outdated medical and societal term. I think that we need to focus this conversation on scientific references rather than personal beliefs and philosephy/theology.

Physiological changes persist long after withdrawal from alcohol. Look up post acute withdrawal syndrome, many alcoholics have persisting sub-acute symptoms which take months or a couple of years to abate. A similar phenomena happens with benzodiazepines. See this paper where re-exposure in people without an "addictive disease" to a single very low dose of diazepam up to 2 years post-withdrawal led to a rapid return of withdrawal symptoms. You appear to be coming from this from the angle of alcoholism/alcohol dependence is a 100 percent psychological/behavioural problem and physiological changes (neuroadaptations) induced by alcohol have no role to play in the relapsing nature disease/disorder. It is already reliably sourced that alcoholism/alcohol dependence is a mixture of behavioural as well as physical dependence.--Literaturegeek | T@1k? 18:35, 19 April 2010 (UTC)

A further point that I would like to make, if persisting neuroadaptational changes as a direct result of alcohol dependence are finished with after a week or two of detoxing, why is acamprosate effective in reducing relapse? Acamprosate works by reducing excessive glutamate activity. A very brief description, of what happens neurologically, alcohol enhances GABA activity, with chronic alcohol misuse, the body thinks this is abnormal and a physical dependence is formed to counter excess GABA, one of the mechanisms of tolerance and physical dependence is to increase glutamate activity to counteract the excessive GABA activity. Glutamate is excitatory, whereas GABA is CNS depressing. The reason for the excessive glutamate activity is a direct result of physiological tolerance and dependence which persists for at least one year, and in part explains the cravings and post-acute withdrawal symptoms (at a subacute level from early withdrawal). Acamprosate is typically prescribed for 1 year and increases abstinence rates.--Literaturegeek | T@1k? 18:52, 19 April 2010 (UTC)

I think this is a healthy debate concerning the name of the article, what terms should be used within the article, and whether the DSM's dependence definition should be a separate article. For Wikipedia, I support the article title of "Alcoholism," because that is by far the most widely used and most encompassing term. After reading the above discussion, I'm not convinced that "Alcohol Dependence" should be a separate article, because the DSM and ICD are not universally used or regarded as the only way to categorize the term. It is not clear that the DSM's definition of dependence deserves another entire article, but I think it is useful to use the DSM to define the symptoms, but it may be better in context of other definitions used in various cultures and the literature, like ethanol intake cutoffs, the CAGE, etc. (in other words, the article right now does a great job!). Using the term "alcoholic" within the article makes it much easier to read in an encyclopedic sense, but any time literature or statistics are referenced it would be helpful to know which specific definition they used. As an aside, I prefer "alcoholic" as an adjective for men and women, as opposed to "alcoholics" (as I prefer for "autistic" as an adjective as opposed to the noun "autistics") because it may be less demeaning in my opinion. Also, I think the DSM "Withdrawal" (as opposed to abuse or dependence) definition should be added in more detail, maybe I'll get around to it this summer if nobody else has yet. Thanks for all your hard work! -kslays (talk • contribs) 14:13, 24 April 2010 (UTC)

You are welcome and thank you for your comments. :) The article that needs the most work after this one (if you are interested) I think is binge drinking.--Literaturegeek | T@1k? 18:26, 26 April 2010 (UTC)

Thanks Kslays. I'm interested to see how the DSM's "Withdrawal" differs from the Wikipedia version. Maybe, though, we should link through to that version (if we don't already) and maybe contribute to that one to be sure it contains the DSM version?

In reference to LitGeek's post, There's a lot to discuss. Part of the problem is that you're still talking about alcoholism as if it were a single thing. Trajectory analysis has identified at least five differentiable conditions that we can call alcoholism. Here is a page that describes four of them; I haven't been able to find the NIAAA article that divides it into five.

Let's isolate hangovers. The wikipedia page says that hangovers are theorized to be caused by "Hypoglycemia, dehydration, acetaldehyde intoxication, glutamine rebound, and vitamin B12 deficiency". My assertion was regarding glutamine rebound, and yours referred to acetaldehyde, so let's just say that both are accurate, but to an indeterminable extent. I think we can further agree that the glutamine rebound portion of it is the only symptom that is relieved by "hair of the dog", and as such encourages continued drinking. We should also be able to agree that glutamine rebound is what results in delirium tremens (which is seizures caused by uncontrolled neural firing). With that in mind, can we further agree that a hangover contains an element that is a lesser form of physical alcohol dependence?

I've made the argument myself that glutamine rebound is a contributor to alcoholism, although it's a thoroughly conquered one. It's role is to discourage heavy drinkers from stopping cold turkey. It is definitely a form of alcohol addiction, kind of by definition. However, as a contributor to alcoholism, it's really only meaningful among the kinds of heavy drinkers that never really sober up. It provides a definite obstacle to the guy on the street, but for your typical addiction specialist,the answer is simple: put them through detox so we can start dealing with the REAL problems.

Got to go deal with household stuff, I'll continue this later. Robert Rapplean (talk) 17:24, 24 April 2010 (UTC)

I read the first page of the article but did not have time to read the other 16 pages of the article. I don't think a rebound effect from a single nights drinking is the same as a physical dependence. You don't go out and have a nights drinking and wake up the next day with a physical dependence, that takes repeated and regular abuse of alcohol to occur. You are more describing a "crash" or "come down", a form of rebound I suppose combined with stereotypical alcohol hangover effects rather than a true physical dependence. If a hangover is a physical dependence then most people have been physically dependent on alcohol which is just not true. I do agree that glutamate "rebound" or hyper-excitability is involved in the withdrawal process and in relapse risk. I think detox has a low success rate unless the alcoholic "wants to quit", (or is persuaded through counselling, advice, guidance, encouragement etc to want to quit), i.e. the psychological dependence needs broken or "weakened". Anyhows, looks like there is no concensus for page move and looks like we are pretty much finished getting the article up to GA status, so lets hope we get a pass in the next day or two. :) Have a great week all.--Literaturegeek | T@1k? 18:26, 26 April 2010 (UTC)

Lead question

The sentence, "It is characterized by compulsive and uncontrolled consumption of alcohol despite its negative effects on the drinker's health and social standing" seems woefully incomplete. I know that leads are typically hammered out in long and often contentious debate, so I didn't want to be disruptive by inserting an edit that may have already been discussed, but it seems to me that something should be said about family and social connections other than status, since they are often the most important and most affected part of the alcoholic's life. Something along the lines of this: "It is characterized by compulsive and uncontrolled consumption of alcohol despite its negative effects on the drinker's health, relationships, and social standing." Tom Reedy (talk) 19:25, 20 May 2010 (UTC)

Thankyou for your suggestion - I see it has already been applied! Lee∴V (talk • contribs) 10:41, 15 June 2010 (UTC)

American Society of Addiction Medicine - new definition of 'addiction'

Of note, the American Society of Addiction Medicine has just completed their new addiction definition: Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in the individual pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by impairment in behavioral control, craving, inability to consistently abstain, and diminished recognition of significant problems with one’s behaviors and interpersonal relationships. Like other chronic diseases, addiction involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.Drgitlow (talk) —Preceding undated comment added 20:57, 11 June 2010 (UTC).

Sounds good, thank you for bringing this to our attention. Is there a source available so that this can be cited in the definition section? It may also be worth adding to the main addiction article as well.--Literaturegeek | T@1k? 23:45, 15 June 2010 (UTC)

Edit request from OASISonline.eu, 28 June 2010

{{editsemiprotected}} Can you add an external link please?

http://www.oasisonline.eu/en/About_Oasis.php

OASISonline.eu (talk) 02:10, 28 June 2010 (UTC)

I would say that we've got the external link section in this article managed well. You may want to add this link to the Open Directory Project. That's the website that is all about links. We're an encyclopedia and link to their categories of link. That's probably the best solution. Dawnseeker2000 02:45, 28 June 2010 (UTC)

 Not done SpigotMap 12:35, 28 June 2010 (UTC)

Age of drinking causality

Have just reverted this recent edit by - User:Ajax151

'It is not entirely clear whether this association is causal, and some researchers have been known to disagree with this view.'

I'm not convinced by these refs, neither say absolutely there is no causal relationship, the first says concludes with 'more research needed' ... and found a review from same journal as second even states

'We found strong evidence for an association between early drinking onset and risk for AD[Alcohol dependency], but less evidence for an association with alcohol abuse.'

A review article from same journal doesn't seem to make much of the lack of causality. (Guerri C, Pascual M (2010). "Mechanisms involved in the neurotoxic, cognitive, and neurobehavioral effects of alcohol consumption during adolescence". Alcohol. 44 (1): 15–26. doi:10.1016/j.alcohol.2009.10.003. PMID 20113871. {{cite journal}}: Unknown parameter |month= ignored (help)). Lee∴V (talk • contribs) 12:20, 2 July 2010 (UTC)

The articles I posted, especially the review article, are sound and reliable sources. There is enough controversy over causality that it needs to be mentioned, regardless of the apparent pseudo-consensus among others. YOU may not be convinced, but that doesn't mean these references are bunk or that others are gospel. And no study has actually proven causality or lack thereof, I am not asserting that it was disproven, only contradicted by some studies. And the study you cite was primarily about proposing theoretical mechanisms if causality was the case--not about proving it.Ajax151 (talk) 15:50, 2 July 2010 (UTC)

A couple of problems, the review source is from 1999 and appears to be being used to cast doubt on newer sources. The other source is a primary source. The last problem is this is a good article, which means sourcing criteria is more stricter than for other articles.--Literaturegeek | T@1k? 23:05, 2 July 2010 (UTC)

While the source from 1999 is a primary source, the review from 2010 is a secondary source and it also cites the first one. These are the same sources I used in the binge drinking article. I know this one is a better quality article, but the sources I cited are reliable ones, and we ought to acknowledge all non-fringe views even if they are in the minority. The wording I used kind of implies minority status anyway, so as not to give undue weight.Ajax151 (talk) 15:57, 5 July 2010 (UTC)

By not convinced - I mean not convinced the refs support the notion that causility does not exist. As a starter for ten,we could keep 'the exact mechansm or degree to which age of drinking affects the chance is unknown' or something like that ? ... Lee∴V (talk • contribs) 12:12, 3 July 2010 (UTC)

No, I think the current wording is fine. Anyone else have an opinion?Ajax151 (talk) 21:25, 3 July 2010 (UTC)

Have read the refs again, the review only quotes the primary source for this argument , putting it into the context of 'age of drinking is not by itself a cause of AD, it's one of several factors' , theat and the paper itself covers studies in non-humans and states that they don't really behave the same as humans in trials leaves me uncomfortable with it. The Prescott and KIndler paper is over ten years old, and as I said earlier says that 'We found strong evidence for an association between early drinking onset and risk for AD[Alcohol dependency], but less evidence for an association with alcohol abuse.' I know there has been some debate about 'alcoholism', 'alcohol abuse' and 'alcohol dependence' so this line seems a bit vague. If there is direct evidence for non-causality there must be more research, otherwise at the moment we can only write 'one paper found that there was evidence for a link with AD, but early onset of drinking by itself seems to be non-causal for alcohol abuse' which isn't much of a line. Maybe I'm misreading the refs but if you believe so we need more opinions Lee∴V (talk • contribs) 11:34, 8 July 2010 (UTC)

You appear to be misreading the references again, and confusing correlation (association) with causality. The Prescott article (you apparently forgot to read the next sentence after the one you cited) read in part as follows:

(Emphasis added) We found strong evidence for an association between early drinking onset and risk for AD, but less evidence for an association with alcohol abuse. The results of twin-pair analyses suggest that all of the association between early drinking and later AD is due to familial sources, which probably reflect both shared environmental and genetic factors. These results suggest the association between drinking onset and diagnosis is noncausal, and attempts to prevent the development of AD by delaying drinking onset are unlikely to be successful

and the review paper that references it:

(Emphasis added) When the entire birth cohort [of rhesus monkeys] was tested is the social group setting during late adolescence/early adulthood (4-5 years of age), there were no differences in the amount of alcohol consumed by subjects who received early exposure and those who did not (Figure 1). This suggests that early exposure by itself may not necessarily lead to elevated alcohol consumption later in life, and that other factors are certainly involved. These findings are in agreement with those that demonstrate the association between an early age of onset of alcohol use and alcohol dependence in humans is noncausal and in fact reflects shared genetic and environmental factors (Prescott and Kendler, 1999).

Granted there is a bit of nuance in the review, but overall it supports the null hypothesis of non-causality. This is a reliable, peer-reviewed secondary source citing a significant minority view. There is no good reason not to include it, and currently no one else seems to be objecting to its inclusion.Ajax151 (talk) 15:16, 8 July 2010 (UTC)

I got mixed up, the 2010 source is a review paper. I do not think the 1999 primary source should be used, it has been contradicted by newer sources and is covered by the 2010 source anyway. The 2010 source, I can compromise with, per WP:NPOV. It is not the most indepth review but it is a review all the same.--Literaturegeek | T@1k? 22:40, 8 July 2010 (UTC)

OK, I'll go with the addition, but think we need to define the research better... e.g. 'The exact mechanism and causality is unknown and some research indicates that the age at which alcohol is first consumed does not, by itself, cause alcohol abuse later in life.' and only need to use the review as a reference. Lee∴V (talk • contribs) 13:12, 10 July 2010 (UTC)

Those words you suggested should be fine, but both references should be used to put the review in better context for the reader.Ajax151 (talk) 22:04, 12 July 2010 (UTC)

Both sources say much the same thing, so I don't know what you mean by context. WP:MEDRS says that we should favour a review over a primary source. The 1999 source should be deleted I think.--Literaturegeek | T@1k? 19:28, 14 July 2010 (UTC)

Edit request from Estradarobert, 29 July 2010

{{editsemiprotected}} i have a picture i would like to put on this page please email me at estradarobert1993@yahoo.com thanks

Estradarobert (talk) 21:50, 29 July 2010 (UTC)

Thank you for your comment and suggestion. Why not register an account on wikimedia commons and upload your file there and then post the link to the file so we can view the picture and add it to the article?--Literaturegeek | T@1k? 22:07, 29 July 2010 (UTC)

Not done for now: Pending upload of image. Dabomb87 (talk) 22:09, 29 July 2010 (UTC)