[Medical Insight 57th] Everything about "Alcohol Dependence" from a psychiatrist.

□ Broadcast Date and Time: November 8, 2024 (Fri) 10:20 pm
□ Producer in charge: Lee Siwoo
□ Author in charge: Kim Bae-jeong and Kim Hyun-jung
□ Cast: Noh Sung-won (a psychiatrist at Hanyang University Hospital)
□ Broadcast channel
IPTV - GENIE TV No. 159 / BTV No. 243 / LG Uplus No. 145
SkyLife Number 90
Cable - Delive No. 138 / Hyundai HCN No. 341 / LG HelloVision No. 137 / BTV Cable No. 152

* The text below may differ from the actual broadcast content, so please check the broadcast for more accurate information.


◆ Noh Sung-won: Hello, I'm Noh Sung-won, a psychiatrist. What I'm going to talk about today is the symptoms and treatments of alcoholism.

◇ Voice actor Park Sang-hoon: We often call people who like and enjoy drinking alcohol a drinker, but if you think of alcohol every time you eat it and habitually enjoy accompaniment, you should suspect alcoholism. The number of domestic alcoholics is steadily increasing from 1.55 million in 2018 to 1.526 million in 2020. However, the number of cases leading to actual treatment is decreasing every year, and the only way to treat alcoholism is to stop drinking alcohol. Let's learn more about the treatments that allow alcoholics to stay away from alcohol on their own without relying on alcohol.

[The Origin of Alcohol]
◆ Noh Sung-won: Yes, when we think of alcoholism, we think of alcohol first. So when did people start drinking alcohol? If you look at the historical records, the beginning of drinking is that people followed the monkey's first drink of the fruit that fell from the tree fermented and became fermented liquor. In a way, it's been a long time with human history, or even longer.

[Understanding Disease]
◆ [Roh Sung-won] Yes, so what kind of disease is alcoholism? Even though drinking a lot of alcohol beyond the socially acceptable level can harm many functions physically, mentally, and psychologically, when it becomes a chronic mental illness, we say it's alcoholism. We usually misunderstand a lot. It's a lack of will, a morally depraved act. A lot of people talk about alcoholics. But this is a misunderstanding. Before the development of brain science, it was often said that it was a moral problem and a will problem, but with the development of brain science, the causes and symptoms of this disease called alcoholism were identified as one of the mental diseases. The reason we can't stop drinking is not a matter of will, but a behavioral disorder caused by the loss of control of the brain over drinking. In other words, chronic recurrent brain disease will be alcoholism. We often talk about alcoholism, but medically it's called alcohol use disorder or alcohol dependence.

[Prevalence of disease]
◆ Noh Sung-won: Then how many alcoholics are there in Korea? As the lifetime prevalence rate reaches 12%, alcoholism is the most prevalent disease among major mental illnesses. The prevalence of men and women is a little different. Men are known to get the disease about three times more than women.

[Diagnosis of the disease]
◆ Noh Sung-won: Yes, so how do you diagnose alcoholism? According to the World Health Organization who, if two or more of the three symptoms I'm talking about now, experts are making a diagnosis of alcoholism. In other words, there is no control over the first drink. For example, how much alcohol you drink, how often you drink, how often you drink, how often you drink, how often you drink, and when you continue to drink, if you don't finish it and you continue to drink, there are a lot of important things in our lives. Family, human relationships, work life, school life, and one's health. When alcohol comes first and foremost, alcohol is more important in my life, it becomes one of the diagnostic criteria. The third is tolerance and withdrawal. Tolerance does not have the desired effect when you drink the same amount of alcohol, so the amount of alcohol increases, or in the case of withdrawal, it is forbidden to develop symptoms that become uncomfortable when you suddenly stop drinking or reduce the amount you drink. For example, if you can't sleep, feel anxious, restless, break out in a cold sweat, your heart palpitates, or you can see nothing now, but when you have this withdrawal phenomenon, it is called alcoholism. If you say more than one of the things I've just told you, you can make a diagnosis. When these dependent characteristics are short, they are alcoholism when they last for more than a year without our diagnosis. It's diagnosed as that. However, if you have this problem every day, it can be diagnosed as alcoholism for more than three months. Let me give you an example of five people. Shall we think about who's an alcoholic? Mr. A drinks every day. Ms. B binge drinks only once a week. C drinks more than three times a week. Ms. D doesn't drink often, but once she drinks it, she drinks it until she becomes insubordinate. Whenever Mr. F drinks, he swears and uses violence. Usually, it's too quiet and quiet, but when you drink alcohol, you change your behavior, so aggressive behavior comes out. Can you think about which of these five people is alcoholism? You can't talk about alcoholism or not with just one aspect. However, these alcohol problems interfere with daily life. And if you have a problem with your ability to control your drinking, all five of these people can be alcoholics.

[Brain anatomy]
◆ [Roh Sung-won] So where is the part of the brain that controls this control? In our brain, there is a part called the limbic system that controls emotions and moods, and there is also a part called the basal nucleus. We have a frontal lobe that governs our brain's regulatory ability to act as a control tower. These three sites are involved to form the midbrain limbic dopamine circuit, which we also refer to as the compensation circuit. The reason we feel pleasure when we do something is that dopamine is now secreted, and when a disease occurs in this area, an addiction disease occurs. Alcohol activates the compensation circuit, releases dopamine, and when this dopamine is released, feelings of relief, happiness, excitement, and joy are created. This is the brain's compensation circuit, and this is the problem with control when a disease occurs.

[The effect of alcohol on our bodies]
◆ [Roh Sung-won] Let's look at the effects of alcohol on our bodies. It's so diverse that there are no parts that don't affect us from head to toe. First of all, it's a very important part of our brain. It destroys brain cells, causing disorders in cognitive function and memory. It can also cause gastrointestinal bleeding or cancer in any area from the esophagus to the intestine. It also puts a strain on the liver, which can lead to hepatitis, cirrhosis, and liver cancer. You can suddenly have a heart attack because you weaken your heart muscle. It also makes you vulnerable to various infectious diseases because it causes impairment in immune function. In addition, drinking may also affect the loss of sexual desire due to sexual dysfunction, various impotence, and difficulties in various sexual functions. In addition, bones can be easily fractured due to osteoporosis or bloodless necrosis of the femoral head of the hip joint. These will be the effects of our alcohol on our bodies. Yes, drinking affects our brains and changes our behavior. I'll tell you the change in behavior according to blood alcohol concentration. When the blood alcohol content is 0.02 to 0.06 grams per deciliter, the body relaxes, feels better, and becomes a little chatty. People who don't talk much usually talk a lot. You start to experience difficulties in concentration again. 0. If it is between 06 and 0.1, the cooperative movement will be impaired. So if we drink and drive, even people who usually drive well can cause accidents. 0. When you're between 1 and 0.2, you get hyperactivity and aggression, so you get into disputes with people around you, or you suddenly get angry and fight over something that's not big. 0. Between 2 and 0.3, consciousness or memory is lost. 0. In the case of 3 to 0.4, confusion occurs and central nervous system paralysis occurs. 0. Between 4 and 0.5, you're now in a coma. 0. If it's over five. The breathing center is paralyzed and you can no longer breathe, leading to death. In this way, alcohol can cause changes in our behavior in each concentration of our body.

[Genetic show]
◆ [Roh Sung-won] So what causes this alcoholism? It can be largely divided into genetic causes and environmental factors. Among them, genetic factors are known to affect about 60%. It's very big. You can see that there is a very high possibility of alcoholism from birth. So, children of alcoholics are four to five times more likely to become alcoholic than children with parents who do not. If you have a very high percentage of people whose parents have suffered from alcoholism, the only way is not to drink at all. It's better to think that drinking alcohol can lead to alcoholism rather than healthy drinking. If we do our research. If we do quantum research, we adopt them. If biological parents are alcoholic, they are highly likely to develop alcoholism despite being adopted into a healthy family as soon as they are born, and on the contrary, children born to non-alcoholic parents are more likely to become alcoholic when they are adopted by alcoholic parents. This story shows that genetic factors play a large role rather than environmental factors. Also, among genetic studies, there is a twin study. We have two types of twins. There are identical twins and fraternal twins. Identical twins share much more genetic information. Therefore, when comparing the disease concordance of identical twins with that of fraternal twins, if one of the identical twins is alcoholism, the other one is much more likely to be alcoholism. In other words, it can be understood that it is much more affected by genetics.

[Environmental Factors]
◆ [Roh Sung-won] That doesn't mean this disease is caused by genetic causes alone. It is said that environmental factors affect about 40%. As a psychological cause, drinking alcohol to relieve tension and drinking alcohol to reduce psychological pain is likely to lead to alcoholism. Another thing is because of socio-cultural reasons. It's a culture where you're more likely to be addicted to alcohol if you live in a society where you're more tolerant of drinking than if you're in a social culture where you're not. Accessibility is also very important. Depending on whether you are in an environment where you can buy and drink alcohol or how easy it is to get alcohol, you are more likely to become addicted to alcohol if you live in a highly accessible society. So this is why adolescents and young people are very strict about selling or restricting drinking.

[Alcohol dependency = family illness]
◆ Noh Sung-won: Alcoholism himself is a difficult disease, but his family is also in a lot of pain. When we listen to the stories of the families of alcoholics, there are many heartbreaking stories, and there are many cases where they suffer so much that they cannot get sick without being depressed, so we call alcoholism a family disease. Of course, if you have an alcoholic family member, the rest of the family will have a lot of mental pain and conflict. There are a lot of difficulties, but there are also family problems. There are many cases where families don't know this well. For example, there's the concept of joint dependence. What co-dependence means is that if an alcoholic is in my family, it's the psychopathology of the rest of my family. The characteristic of this disease is that you don't know that you actually have such a problem. Co-dependence is the family's constant stimulation to keep alcoholics drinking. And when you show a very permissive attitude toward drinking and say that you want to get treatment to solve the drinking problem, you don't like it and don't like it, but rather say and do things that interfere with treatment. The problem is that most people don't know that they do. So there's also the psychopathology of families that has a very bad effect of keeping alcoholics in the family without ever recovering. When treating this, there are many cases in which the patient relapses again if the family realizes the problem and does not deal with it. How do families overcome these problems? It is also very important to meet an expert and get counseling. Self-help group. We're called the Self-Help Group. There is a group meeting that helps themselves. The family gathering is called AL-ANON. There is also a group of alcoholic children and a group of teenage children, so the group is called AL-ATEEN. You can go to AL-ANON or AL-ATEEN meetings and talk about your problems honestly, exchange good information, share difficult emotions, and empathize with each other, and see how other families helped patients, overcame them, and recovered from the disease. Going out to a self-help group like that and having a conversation with your family can help with treatment.

[Cure of Disease]
◆ Noh Sung-won: So how will the patients be treated? Let me explain the treatment of alcoholism. Yes, first of all, I'll explain it in two ways. The first is detoxification treatment, and the second is anti-recurrence treatment. Detoxification treatment is what people who drink a lot experience when they start a life without alcohol for the first time in our diagnostic criteria. It's withdrawal symptoms. The best way to relieve these withdrawal symptoms, which cause you to be unable to sleep, nervous, nervous, cold sweat, and very nervous, is actually to drink again. Since drinking alcohol again is not a cure, it reduces withdrawal by administering a similar substance, a central nerve inhibitor, instead of alcohol. The representative drug will be the benzodiazepine drug. If you take the medicine and take it or get an injection, you can survive without drinking alcohol because you can minimize withdrawal, which is usually caused by not drinking alcohol. What's important at this time is taking vitamins. Among vitamins, vitamin B1, the very vitamin B1 that we call thiamine, is a very important ingredient for detoxification treatment. It's because most alcoholics don't eat much anymore. I don't eat snacks evenly like this. Therefore, the supply of nutrients is a little short, and among the essential nutrients, vitamin B1 that affects the brain related to our memory is vitamin B1, and it is important to take vitamin B1 thiamine in a high dose when detoxifying treatment is performed. In that way, withdrawal symptoms take an average of about two weeks, short people can be a week, and people who go to withdrawal symptoms for a long time may go up to a month, two months, and three months, but most of them are usually treated for detoxification within a month or less than two weeks. After dealing with all symptoms of withdrawal through detoxification treatment, we move on to treatment to prevent recurrence. The purpose of treatment to prevent recurrence is to increase motivation for abstaining from alcohol and to help you adapt again to a new life without alcohol. There are two main ways. I will explain it divided into medication and psychosocial treatment. First of all, it's medication. For drug treatment, people usually use anti-angirloom drugs. An anti-angal medication is the desire for alcohol, which we call a craving. It is also expressed as a craving for alcohol, and it is a drug treatment that has the effect of reducing that craving. Currently, two drugs are approved by the Ministry of Food and Drug Safety and are being prescribed to patients. It is an ingredient called acamproate and naltrexone. Acamprosate is known to have the effect of continuing to extend the duration of non-drinking, and naltrexone works on the brain and reduces the pleasure of the reward circuit. In other words, it is known that drinking alcohol does not taste very good and does not have much enjoyment from alcohol, so it helps reduce the amount or frequency of drinking alcohol. That's why I recommend you to get medication. There are many psychosocial treatments, and among them, there is motivation-enhancing treatment. Motivation-enhancing therapy is to treat on the premise that I also have motivation for change. It will be an interview technique that draws out the motives of those who have the motivation to change themselves, but do not practice it, do not come up with it, and do not find it. It will be a counseling technique that can mainly treat people who cannot recognize that they have a disease, mainly alcoholism, and alcoholism. The next most commonly used treatment is cognitive behavioral therapy. Our actions mostly start from our thoughts. Depending on how we think, our emotions change, and symptoms and behaviors change depending on our emotions. Cognitive behavior therapy is a treatment that changes cognition through practice of changing thinking, which is the starting point. For example, I don't know under what circumstances I kept drinking. Most of the time, but it seems that there is no connection to drinking that stimulates me by making me recognize and realize such high-risk drinking situations on my own, but it is also very important in cognitive behavioral therapy to realize that it is related and to avoid such stimuli. There are times when we have no choice but to go to a drinking party. In that case, you should not be confident about how you refuse to drink alcohol. When you refuse, you have to look them in the eye and say no firmly. Oh, I'll drink it later. If you talk like this without confidence, the other person will attack you more. Since you are recommending more alcohol, you can confidently and confidently say no right away, and the important thing at that time is that instead of alcohol, it can be a good way to propose and toast these alternatives like water or other drinks. Also, how to cope with longing when you think of alcohol can be learned through cognitive behavioral therapy. Also, the self-help group of our patients, A.A., A.A., is an abbreviation of (Alcoholics Anonymous). In Korean, it means anonymous alcoholics. It will be a self-help group gathering where the recoveries will share their experiences on their own, deliver helpful messages to those who are concerned about recurrence, and tell their stories honestly to show various therapeutic effects. At the self-help group meeting, A.A. will accept that I am helpless in front of alcohol based on the 12-step treatment, and from that, it will be a life-changing treatment step by step. All of these treatments are proven to be effective, so rather than thinking that I would be treated with just one or two, getting all of the treatments at once can increase the probability of treatment and recovery.

[Medical AI Q&A]
◆ Noh Sung-won: Yes, the viewers sent me a lot of questions about alcoholism. Shall we check it out together?

[Two cans of beer every day] Alcohol dependence? ]
◇ Y-ON (AI Anchor): My husband has been drinking 2 cans of beer and going to bed every day since a year ago after work. Is it alcoholism by any chance?

◆ Noh Sung-won: You can't tell whether drinking two cans of your beer every day is an alcoholism or not just by saying that. In fact, the bigger criterion is whether drinking interferes with daily life, interpersonal relationships, and family relationships rather than the amount or frequency of drinking. I'm going to ask you four questions right now, and you can answer yes or no. I think it would be good to ask your family four questions like this and look at how many questions you answer yes. First, do you think you should stop drinking or cut back? Do you feel annoyed and hate being nagged about your second drinking problem? Do you feel guilty or regret after your third drink? This is the fourth and last question. Do you drink hangover the day after you drink? When you ask your husband these four questions, you can suspect alcoholism if they say yes to both. If you said three or four are, it is almost certain that you are addicted to alcohol. You'd better hurry up and see an expert for consultation.

[Alcoholics can be treated for forced hospitalization?]
◇ Y-GO (AI anchor): My father's alcoholism symptoms make my family so tired. Is there any way I can get them treated through compulsory hospitalization?

◆ Noh Sung-won: From your family's point of view, how frustrating is it to force them to be hospitalized and receive treatment? I think that's what you're worried about. In fact, this is not uncommon. Well, in the case of forced hospitalization like this, we now legally say protected hospitalization. According to the current Mental Health Welfare Act, mentally ill patients at risk of self-harm can be admitted to a protected hospital without the patient's own consent if they meet with a psychiatrist, diagnose them, and consent from two or more protectors. We usually talk about being forced into a closed ward. The reason is that if you don't hospitalize others when there is a risk of self-harm or suicide and when they can hurt others due to aggressive behavior, this problem can occur, so it is an inevitable choice for the patient's life, safety, and recovery.

[Alcohol dependence treatment record, impact on employment?]
◇ Y-ON (AI anchor) : He is in his early 30s preparing for employment. I'm addicted to alcohol because I drink every day due to my failure to get a job. I want to get treatment, but I'm worried that I'll be disadvantaged in getting a job because I have a medical record. What should I do?

◆ Noh Sung-won: There are many young people who actually think about mental health treatment and hesitate because of these problems. One thing is right and one thing is wrong. I'll explain it to you. First of all, it's true that it goes on the record. When we receive medical treatment at the hospital, of course, the medical practice will be recorded in the medical record. This part is true. However, you have the right to copy or view these compulsory records. You don't have to worry about keeping it confidential because no one can see these records without their consent. Therefore, there is no disadvantage in getting a job just by the fact that you have been treated in a mental health department. It's impossible for a third party to see this medical record. Rather, if the disease worsens without treatment, it will be rather difficult to work or get a job. Getting treatment well and recovering physical and mental health to create a good job will be a good way to get a job.

[Let's remember this]
◆ [Roh Sung-won] Yes, I've been talking about alcoholism. Addiction is not only an individual's health problem, but it also causes family suffering conflicts and sometimes social damage. However, we need a social atmosphere that gives us a chance to get treated instead of blaming people with drinking problems. Alcoholism needs to be recognized as a curable disease. That's all I've prepared. I hope my story today helped you all have a happy life a little bit. Thank you.