Cirr

hosis

dea

ths/

100,

000

10

20

30

Per capita alcohol consumption liters/yr10 155

US

Norway

Japan

Sweden

ItalyAustria

France

Switzerland

Luxembourg

Canada

Belgium

GermanySpain

Portugal

EireNZ

Netherlands

AustraliaUK

Finland

Transnational alcohol consumption & cirrhosis

Alcohol Abuse in the U.S.

60% men, 30% women > 1 alcohol-related adverse life event

High morbidity and mortality, violence, accidents, social and legal problems • >100,000 deaths / yr• $167 billion annual cost

Parkinsonism in alcoolism

Fetal Alcohol Syndrome

>10% of children exposed in utero to alcohol toxicity

7-14 drinks/wk (particularly > 5/occasion) can cause moderate fetal damage

FAS: growth deficiency, abnormal facies, mental retardation, attentionaland behavioral problemsFAE: learning disabilities, intellectual impairment, behavioral problems

The life of an alcoholic can be summarized as: preoccupation/anticipation,

binge/intoxication and withdrawal/negative affect

Koob, 2003

Reward pathway -- mesolimbic dopamine system

Ethanol interacts with neurotransmitter receptors (post-

synaptic effects)Ligand-gated ion channels (fast)glutamate GABAA glycine acetylcholine

(nicotinic)

Metabotropic receptors (slow)norepinephrine dopamineGABAB acetylcholine

(muscarinic)serotonin purinergic

(adenosine)

Comorbidity with alcoholism Drug abuse (opioids, cocaine,

cannabis) nicotine addiction antisocial personality disorder major depression anxiety disorders bulimia nervosa

thiamine 100 mg, folate 1 mg, andliquid multivitamins, in sodium chloride 0.9%without glucose.