The City of New York’s Medical Examiner Report concluded that Heath Ledger’s cause of death was “the result of acute intoxication by the combine effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam, and doxylamine”.

Recent investigations and medical warnings have concentrated on the lethal combination of prescription drugs such as narcotic analgesics and sleeping aids. However, the medical community have ignored – and have been ignoring for some time – the underlying prescription drug class that often leads to habitual drug dependency with dangerous lethal consequences. Two of the drugs listed on Ledger’s report are the most insidious, potentially dangerous, highly prescribed and, yet, the most overlooked and under-estimated by doctors. These drugs can start the chain reaction that potentially leads to Vicodin or sleeping pill abuse.

The first time I saw Heath Ledger, it was by accident. My date and later to-be husband, Nick, took me to see ‘The Sixth Sense’, finally succumbing to peer pressure to guess ‘the big surprise ending’. By now, ‘The Sixth Sense’ was off the major theatre chain circuit and only screening in small suburban independent theatres, which led us to experience one of those now rare events: a double-feature matinee. The first movie was ’10 Things I Hate About You’.

Heath Ledger winning Best Supporting Actor for “The Dark Knight”

Well passed ‘teen’ movies, even those with Shakespearian-based scripts, we shyly admitted to liking ’10 Things’. Wow, I really like the male lead, what was his name? “He’s Australian, you know”, replied Nick. And in typical Aussie-fashion, I was doubly impressed and now stupidly filled with national pride. Another brilliant Australian up-and-comer to join the rapidly increasing queue to grace Hollywood screens.
Years later, I would often grab the DVD to fill a cheerless afternoon and find myself watching and rewinding the same scene. Over and over and over again. My secret guilty pleasure. Heath sliding down the pole, microphone in hand, singing “You’re just too good to be true, can’t take my eyes off of you . . . ” The brass band kicks in. And that charmingly defiant half-run, half-prancing across the school steps. The scene is brilliant. It’s inexplicable. He simply has that old-fashioned ‘it’ factor . I’m not a star-struck fan and was never one of those teenagers with movie-star idol posters plastered all over my bedroom walls, but this kid’s got talent.

And then came those scene-stealing roles that totally blew us away. The Patriot. Monster’s Ball. And finally leading-man status and an Academy Award nomination. By now, we were just used to having another famous Australian up there with the rest of the world’s great talent churning out an endless array of diverse, yet illustrious film roles.

heath ledger singing “cant take my eyes off you”

We had no idea. It was not endless. It ended on 22 January 2008.
When people who I’ve never met but greatly admire die, I’m sad. But I’ve never cried before. I have never before felt that heart wrenching overwhelming shock that lasted for days after I heard the news. This time it was somehow more personal. As soon as I read the detailed list of the first report of his deathbed scene, I intuitively knew how he died.

Ten days later the final medical examiner’s report confirmed my suspicions.
Hollywood is ‘Xanax-city’. Feeling down, pop a Xanax. Feeling stressed, pop a Xanax. Need to perform at your very best, pop a Xanax. A-list stars feel the pressure to provide A-grade performances when working on multi-million dollar films. There’s too much money at stake. The intense stress, both internal and external, is immeasurable. The studios are risking billions, paying the stars millions, and the actors are unnaturally subjected to more pressure than we mere mortals can imagine.

Heath Ledger, himself, admitted that after the worldwide release of ‘A Knight’s Tale’ with its instant paparazzi-bulb-flashing stardom, his stress levels increased ten-fold.
Xanax is the trade name of the generic anti-anxiety/tranquilizer prescription drug, alprazolam, listed in Ledger’s toxicity report. The other anti-anxiety drug was diazepam, or more commonly known as Valium. These drugs are from a class of commonly prescribed tranquilizers known as benzodiazepines or simply referred to as benzos.

According to the latest National Health Study, approximately 10 million scripts of benzos are written annually in Australia alone with its meager population of 20 million compared to 300 million in the US. Many doctors will write a script for benzos faster than a speeding bullet. But the real danger is that too many of them do not know the long-term effects these drugs have on your system, how to give their patients the correct advice when administering or monitoring the dosages, and – more frighteningly – how to manage their patients’ benzo withdrawal program.
Firstly, this is how benzos affect your body – or more importantly – your brain. Benzodiazepines increase, or rather, enhance your brain’s main neurotransmitter, commonly known as GABA. Eventually, and this can be as quickly as 3 to 4 weeks if taking a daily dose, your brain will stop producing its own GABA and rely totally on the artificial benzo.
GABA is the most important neurotransmitter because it affects just about everything else. Primarily it enhances the brain’s other neurotransmitters such as Serotonin and Dopamine. All of the brain’s neurotransmitters have important functions such as, voluntary movement of the muscles, wakefulness, sleep, memory function, sensory transmission – especially pain, and much, much more.
The problem is that from this point on your brain needs more benzo as tolerance starts the downward spiral, and the brain needs higher and higher dosages to obtain the same effect. If the patient is not given the correct dosage or management advice, that insidious and often-undiagnosed disorder known as Benzo Withdrawal Syndrome (BWS) will start its ugly and potentially dangerous descent.
BWS is known by experts in the field for its severity and prolonged nature. It may take years to fully withdraw from benzos, even with proper care and supervision. Without this knowledge, the unwitting patient can suffer from over 30 symptoms, the most common being unrelenting insomnia, severe pain and mood changes. People who have been taking benzos for a relatively short time can experience withdrawal symptoms even whilst taking the drug. In addition, if you have been taking them for a prolonged time, and then suddenly stop, severe symptoms will occur. Or, at the very least, more pain, more depression and unrelenting insomnia.

Heath Ledger dies. breaking news report

When we now read about Heath Ledger’s complaints about his incessant insomnia and the possession of strong painkillers, does this sound familiar? Everything points to extreme Benzo Withdrawal, but no-one is exclaiming its dangers. In fact, most GPs and even hospital doctors admit they know very little about Benzo Withdrawal. Some even refer their patients to drug rehabilitation canters – an absolute no-no according to benzo counselors. Benzo withdrawal is the exact opposite to alcohol or street drug dependency. You don’t want to abruptly eliminate the benzo from your body, as they often do in drug rehabilitation. The brain needs the benzo. One must gradually withdraw the artificial benzo until the brain can eventually increase its own GABA. Sudden cessation of benzos can cause severe problems such as seizures and blackouts.
When in BWS, trained counselors advise against taking any medication or drugs whatsoever. Paracetamol is probably the only thing the body can cope with for pain relief. Nothing else. Even codeine is forbidden. Also, one should totally refrain from alcohol, caffeine, and all stimulants. There is a strong protocol to be followed and without this knowledge, the patient is easily put at great risk.
The Ashton Manual, the acknowledged benzodiazepine ‘bible’, warns:
“Drug interactions: Benzodiazepines have additive effects with other drugs with sedative actions including other hypnotics, some antidepressants, major tranquillizers or neuroleptics, trifluoperazine, anticonvulsants, carbamazepine, sedative antihistamines, promethazine, opiates (heroin, morphine, meperidine), and, importantly, alcohol. Patients taking benzodiazepines should be warned of these interactions. If sedative drugs are taken in overdose, benzodiazepines may add to the risk of fatality. ”
The real problem is that there are extremely few experts in treating BWS; they will not include your local doctor, hospital, or drug clinic. However, there are good BWS specialists that can be extremely helpful, but they are usually found in specially funded tranquilizer recovery clinics.
One must ask, why don’t doctors know about this? The problem is they simply don’t. Is it their fault or the pharmaceutical companies that profit from these addictions? There is little or no dissemination of information within the community, the medical fraternity or from the pharmaceutical companies about benzodiazepines. And, according to BWS counselors working in the field, there is insufficient research or empirical studies on the effects of benzos and BWS management to assist them with their intensive workloads.
Why? Who is at fault? Who is responsible for remedying the situation? Why are the people who write the scripts uninformed about the after-effects and potential dangers associated with benzodiazepines?
Can our beloved Heath Ledger’s death be at least one catalyst that will draw this devastating travesty to the public’s attention to demand more information?
I hope so.

Heath Ledger – Dark Knight Joker Video, Incredible Acting by an Incredible Actor.

REFERENCES:
1. Professor C Heather Ashton DM, FRCP, The Ashton Manual, 2002. Available from www. benzo. org. uk.
2. Dr Reg Peart, Select Committee on Health Minutes of Evidence, House of Commons, UK. June 1999. “This submission by Dr R F Peart, National Co-ordinator of Victims of Tranquillisers concerns the nature, causes and consequences of 40 years of Benzodiazepine dependency, arguably the biggest medically induced health problem of the 20th Century”. Available from www. parliament. uk.
3. Mayo Clinic Staff. How You Feel Pain. 2007. The Mayo Clinic. Available from www. mayoclinic. com.
4. Benzodiazepines. 2007. Reconnexion (formerly TRANX – Tranquilliser Recovery and New Existence), Melbourne, Australia. Available from www. tranx. org. au.
5. Charles S. Hirsch, M. D. , Chief Medical Examiner. The City of New York’s Medical Examiner Report – Heath Ledger Cause f Death. Department of Health & Mental Hygiene, Office of Chief Medical Examiner. 6 February 2008.
6. Sheila Marikar and Richard Esposito. DEA Investigating Ledger Overdose, Feb. 6, 2008. ABC News (USA).
7. Amy Westfieldt & Stephanie Nano. Accidental Overdose Killed Heath Ledger. 7 February 2008. Associated Press.

Heath Ledger’s Last Interview Video. He died just a few weeks later.

HEATH LEDGER has been immortalized in paint following his shock death last month.

The Brokeback Mountain star is the subject of Vincent Fantauzzo’s artwork titled Heath.

The Australian artist hauntingly painted the piece just weeks before his friend’s death.

In the portrait Heath is surrounded by two ‘mind spirits’ whispering into his ears.

Vincent says the whispering spirits represent Heath’s inner thoughts.

At just 28-years-old, the Aussie actor was pronounced dead after accidentally overdosing on a cocktail of six prescription drugs in his New York apartment.

The picture of the Hollywood hunk is being exhibited at Sydney’s Art Gallery New South Wales as an entry for the 87th Archibald Prize.

The award is one of the country’s oldest and most prestigious art prizes and this year’s winner will be announced on March 7.

This article and others like it can be found at http://www.howdoigetoffdrugs.com

1. Why Do People Get Addictions?
The reasons for addiction are complicated and vary with each and every individual. These same reasons may be difficult for us to understand, and even a lot more difficult to resolve. Drug and alcohol rehab in recent years has taken a hard and diverse approach to the problem of addiction. Taking in consideration are the physical, emotional, and even nutritional factors that may be causes. Whether you’re seeking help for yourself or whether you are a concerned friend or family member of someone who is in a very dangerous grip of addiction, be confident that you are not the only one. Addictions come in varied forms, some are dangerous and some are not.

2. The Physiological Approach
It doesn’t mean that just because you are encountering a dangerous addiction it’s alright to think that you are different from everyone else. It only means that you’ll need to seek out specially qualified help. Many physiological and chemical imbalances that occur in our bodies and brains may contribute or cause our feelings of depression, that can lead us into addiction as we try to self medicate to compensate for our emotional distress. We are living in an era where many problems like chemical depression and blood sugar imbalances are easily diagnosed and treated. Often, addicts who treat these underlying problems will experience great relief from the urge to feel better by drinking.

3. Blood Chemistry
The best and most popular idea we have of drug rehabilitation is the old 12-step group therapy that we so often see on television shows and movies. The fact is, science has a lot more to tell us about how our bodies and brains respond to all kinds of substances. A lot of evidence suggests that when a physiological or chemical imbalance is occurs in the brain no matter what the cause, that individual will try to compensate for the imbalance he is experiencing by self-medicating with drugs. Modern drug rehab programs often use this approach to look for chemical brain imbalances to help their patients recover. In addition to this, imbalances in blood chemistry can also lead to drug and alcohol addiction. Having problems such as low blood sugar can lead someone to self medicate so that he can cure any fatigue or anxiety that he may be feeling. A balanced nutritional intake and exercise have shown themselves to be aids in the process of drug rehab.

4. Social Theory
Usually people who are deeply addicted often have neglected themselves, so by finding a diet and exercise program, it can really lift their self image. Another advantage of exercise to anyone who is an addict is that it also provides a natural high that can help an addict to get through the rough periods in his rehabilitation. Some individuals may be comfortable with the idea of group counseling while some may have difficulty in comprehending it. An option for these kinds of people is one on one therapy, where a therapist can reach out to the deepest and most personal aspects of an addict’s life. Looking for answers for addiction and possible recovery is an extremely difficult task to anyone. It takes a lot of devotion and time to even see the smallest of developments. Being able to find the right place to do the work toward recovery is an important step. The wants needs of each and every addict are different from each other, and the process of finding a place to fully recover can be a very deep, difficult, personal and intense process.

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The Internet is a powerful resource for education, entertainment and business. Unfortunately, the Internet is also a haven for selling and buying all sorts of drugs without prescription. Websites offering to sell pain relievers, uppers, downers and steroids without a prescription can be readily found using search engines. Studies conducted at the University of Pennsylvania found that the Yahoo and Google search engines list websites that offer to sell highly addictive prescription drugs without prescription.

But buyer beware! These medications are illegal to possess without a valid prescription regardless of what the website might claim. Many "No Prescription Websites" mislead potential customers into thinking that they are legitimate by making false claims of legality. In fact, it is illegal to possess medications in the United States without a valid prescription.

Many no prescription websites ship counterfeit, expired or simply bad drugs from countries that provide little or no oversight or control. You don’t know what you are getting when you deal with an online pill mill. In some cases, the website will simply take your money and send nothing at all.

Of even greater concern are the websites that actually ship the drugs without prescription. Medications such as opioids (such as Vicodin, codeine or oxycodone), sedatives like Xanax and Valium, and stimulants (Ritalin, Adderall) are potentially addictive and can easily be misused with disastrous results. Just because a drug comes in the form of a pill doesn’t mean it is safe. There are more people abusing prescription drugs than heroin and cocaine combined.

Young people are particularly vulnerable to Internet-based drug dealing because they have grown up using the Internet and don’t realize its potential risks. Somehow, professionally created websites provide an illusion of safety and professionalism. However, just because a website has the image of a doctor on it does not mean a doctor has had anything to do with the drug sales. Sadly, there are several reports of young people who have died from drugs they bought over the Internet without prescription.

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FIVE THINGS TO KNOW ABOUT GETTING DRUGS OVER THE INTERNET WITHOUT A PRESCRIPTION

• 1. Look for unexpected credit card use.
• If unexpected charges appear on your credit card, call your credit card company and find out what is happening. It is possible that your card is being used to buy drugs online without prescription.
• 2. Know your child’s online friends.
• Just as you should know the friends your child spends time with, pay attention to where they go online, too. Question your child if he or she is visiting online pharmacies or drug-promoting websites. If your child has already been treated for a substance use problem, the risk of relapsing and finding trouble on the Internet may be even greater.
• 3. Look out for unexpected packages with unrecognized names.
• If unexpected packages arrive at your home addressed to your child or a name that you do not recognize insist that your child open the package in your presence.
• 4. Get computer help.
• If you have reason to suspect that your child is using the computer to obtain drugs illegally, seek two kinds of professional help: a) an addictions specialist to address the substance use problem and b) someone to secure your computer so that you can ensure that it is used safely. In most communities there are computer service companies that can help you set up controls over your computer (often called filtering or blocking software, or software programs that monitor what websites are being visited).
• 5. For medications prescribed by a doctor only, use online pharmacies with the Verified Internet Pharmacy Practice Site (VIPPS) certification.

This is a voluntary certification program initiated by the National Association of Boards of Pharmacy. Some online pharmacies will simply take your money and run, others sell counterfeit and expired drugs, while others deliver the actual drugs – illegally. Buying medications without a valid prescription is illegal and unsafe. Websites which have the VIPPS Seal subscribe to safe online pharmacy practices and operate legitimately.

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Although not all of these definitions specify current and on-going use of alcohol as a qualifier for alcoholism, some do, as well as remarking on the long-term effects of consistent, heavy alcohol use, including dependence and symptoms of withdrawal.

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While the ingestion of alcohol is, by definition, necessary to develop alcoholism, the use of alcohol does not predict the development of alcoholism. It is estimated that 9% of the general population is predisposed to alcoholism based on genetic factors.[citation needed] The quantity, frequency and regularity of alcohol consumption required to develop alcoholism varies greatly from person to person. In addition, although the biological mechanisms underpinning alcoholism are uncertain, some risk factors, including social environment, stress,[3] emotional health, genetic predisposition, age, and gender have been identified. 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. Also, studies indicate that the proportion of men with alcohol dependence are higher than that of the proportion of women, 7% and 2.5% respectively, although women are more vulnerable to long-term consequences of alcoholism. Around 90% of adults in United States consume alcohol and more than 700,000 of them are treated daily for alcoholism.[4] Professor David Zaridze, who led the international research team, calculated that alcohol had killed three million Russians since 1987.[5]

Definitions and terminology
The definitions of alcoholism and related terminology vary significantly between the medical community, treatment programs, and the general public.

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Medical definitions
The Journal of the American Medical Association defines alcoholism as “a primary, chronic disease characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking.”[6]

The DSM-IV (the standard for diagnosis in psychiatry and psychology) defines alcohol abuse as repeated use despite recurrent adverse consequences.[7] It further defines alcohol dependence as alcohol abuse combined with tolerance, withdrawal, and an uncontrollable drive to drink.[7] (See DSM diagnosis below.)

According to the APA Dictionary of Psychology, alcoholism is the popular term for alcohol dependence.[7] Note that there is debate whether dependence in this use is physical (characterised by withdrawal), psychological (based on reinforcement), or both.

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Terminology
Many terms are applied to a drinker’s relationship with alcohol. Use, misuse, heavy use, abuse, addiction, and dependence are all common labels used to describe drinking habits, but the actual meaning of these words can vary greatly depending upon the context in which they are used. Even within the medical field, the definition can vary between areas of specialization. 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.

Use refers to simple use of a substance. An individual who drinks any alcoholic beverage is using alcohol. Misuse, problem use, abuse,[8] and heavy use do not have standard definitions, but suggest consumption of alcohol to the point where it causes physical, social, or moral harm to the drinker. The definitions of social and moral harm are highly subjective and therefore differ from individual to individual.

Within politics, abuse is often used to refer to the illegal use of any substance. Within the broad field of medicine, abuse sometimes refers to use of prescription medications in excess of the prescribed dosage, sometimes refers to use of a prescription drug without a prescription, and sometimes refers to use that results in long-term health problems. Within religion, abuse can refer to any use of a poorly regarded substance. The term is often avoided because it can cause confusion with audiences that do not necessarily share a single definition.

Remission is often used to refer to a state where an alcoholic is no longer showing symptoms of alcoholism. The American Psychiatric Association considers remission to be a condition where the physical and mental symptoms of alcoholism are no longer evident, regardless of whether or not the person is still drinking. They further subdivide those in remission into early or sustained, and partial or full.

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Etymology

1904 advertisement describing alcoholism a disease.The term “alcoholism” was first used in 1849 by the physician Magnus Huss to describe the systematic adverse effects of alcohol.[9]

In the United States, use of the word “alcoholism” was largely popularized by the founding and growth of Alcoholics Anonymous in 1935[citation needed]. AA’s basic text, known as the “Big Book,” describes alcoholism as an illness that involves a physical allergy[10]:p.xxviii and a mental obsession.[10]:p.23[11] Note that the definition of “allergy” used in this context is not the same as used in modern medicine.[12]

A 1960 study by E. Morton Jellinek is considered the foundation of the modern disease theory of alcoholism.[13] Jellinek’s definition restricted the use of the word “alcoholism” to those showing a particular natural history. The modern medical definition of alcoholism has been revised numerous times since then. The American Medical Association currently uses the word alcoholism to refer to a particular chronic primary disease.[14]

A minority opinion within the field, notably advocated by Herbert Fingarette and Stanton Peele, argue against the existence of alcoholism as a disease. Critics of the disease model tend to use the term “heavy drinking” when discussing the negative effects of alcohol consumption.

Epidemiology

Total recorded yearly alcohol per capita consumption (15+), in litres of pure alcohol[15]Substance use disorders are a major public health problem facing many countries. “The most common substance of abuse/dependence in patients presenting for treatment is alcohol.”[16] In the United Kingdom, the number of ‘dependent drinkers’ was calculated as over 2.8 million in 2001.[17] The World Health Organization estimates that about 140 million people throughout the world suffer from alcohol dependence.[18][19]

Within the medical and scientific communities, there is broad consensus regarding alcoholism as a disease state. For example, the American Medical Association considers alcohol a drug and states that “drug addiction is a chro

nic, relapsing brain disease characterized by compulsive drug seeking and use despite often devastating consequences. It results from a complex interplay of biological vulnerability, environmental exposure, and developmental factors (e.g., stage of brain maturity).”[14]

Current evidence indicates that in both men and women, alcoholism is 50-60% genetically determined, leaving 40-50% for environmental influences.[20]

A 2002 study by the National Institute on Alcohol Abuse and Alcoholism surveyed a group of 4,422 adult alcoholics and found that after one year some were no longer alcoholics, even though only 25.5% of the group received any treatment,[21] with the breakdown as follows:

25% still dependent
27.3% in partial remission (some symptoms persist)
11.8% asymptomatic drinkers (consumption increases chances of relapse)
35.9% fully recovered — made up of 17.7% low-risk drinkers plus 18.2% abstainers.
In contrast, however, the results of a long term (60 year) follow-up of two groups of alcoholic men by George Vaillant at Harvard Medical School indicated that “return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence.”[22] Vaillant also noted that “return-to-controlled drinking, as reported in short-term studies, is often a mirage.”

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Identification and diagnosis
Multiple tools are available to those wishing to conduct screening for alcoholism. Identification of alcoholism may be difficult because there is no detectable physiologic difference between a person who drinks frequently and a person with the condition. Identification involves an objective assessment regarding the damage that imbibing alcohol does to the drinker’s life compared with the subjective benefits the drinker perceives from consuming alcohol. While there are many cases where an alcoholic’s life has been significantly and obviously damaged, there are always borderline cases that can be difficult to classify. Unless they have M.C. type symptoms, and in these cases are probably alcoholics, no diagnosis needed.

Addiction Medicine specialists have extensive training with respect to diagnosing and treating patients with alcoholism.

Screening
Several tools may be used to detect a loss of control of alcohol use. These tools are mostly self reports in questionnaire form. Another common theme is a score or tally that sums up the general severity of alcohol use.

The CAGE questionnaire, named for its four questions, is one such example that may be used to screen patients quickly in a doctor’s office.
Two “yes” responses indicate that the respondent should be investigated further. The questionnaire asks the following questions:

Have you ever felt you needed to Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt Guilty about drinking?
Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?[23][24]
The CAGE questionnaire, among others, has been extensively validated for use in identifying alcoholism. It is not valid for diagnosis of other substance use disorders, although somewhat modified versions of the CAGE are frequently implemented for such a purpose.
The Alcohol Dependence Data Questionnaire is a more sensitive diagnostic test than the CAGE test.[25] It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol use.
The Michigan Alcohol Screening Test (MAST) is a screening tool for alcoholism widely used by courts to determine the appropriate sentencing for people convicted of alcohol-related offenses,[26] driving under the influence being the most common.
The Alcohol Use Disorders Identification Test (AUDIT) is a screening questionnaire developed by the World Health Organization. This test is unique in that it has been validated in six countries and is used internationally.[27] Like the CAGE questionnaire, it uses a simple set of questions – a high score earning a deeper investigation.
The Paddington Alcohol Test (PAT) was designed to screen for alcohol related problems amongst those attending Accident and Emergency departments. It concords well with the AUDIT questionnaire but is administered in a fifth of the time.[28]

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Genetic predisposition testing
Psychiatric geneticists John I. Nurnberger, Jr., and Laura Jean Bierut suggest that alcoholism does not have a single cause—including genetic—but that genes do play an important role “by affecting processes in the body and brain that interact with one another and with an individual’s life experiences to produce protection or susceptibility.” They also report that fewer than a dozen alcoholism-related genes have been identified, but that more likely await discovery.[29]

At least one genetic test exists for an allele that is correlated to alcoholism and opiate addiction.[30] Human dopamine receptor genes have a detectable variation referred to as the DRD2 TaqI polymorphism. Those who possess the A1 allele (variation) of this polymorphism have a small but significant tendency towards addiction to opiates and endorphin releasing drugs like alcohol.[31] Although this allele is slightly more common in alcoholics and opiate addicts, it is not by itself an adequate predictor of alcoholism, and some researchers argue that evidence for DRD2 is contradictory.[29]

DSM diagnosis
The DSM-IV diagnosis of alcohol dependence represents one approach to the definition of alcoholism. In part this is to assist in the development of research protocols in which findings can be compared with one another. According to the DSM-IV, an alcohol dependence diagnosis is:

…maladaptive alcohol use with clinically significant impairment as manifested by at least three of the following within any one-year period: tolerance; withdrawal; taken in greater amounts or over longer time course than intended; desire or unsuccessful attempts to cut down or control use; great deal of time spent obtaining, using, or recovering from use; social, occupational, or recreational activities given up or reduced; continued use despite knowledge of physical or psychological sequelae.

Urine and blood tests
There are reliable tests for the actual use of alcohol, one common test being that of blood alcohol content (BAC). These tests do not differentiate alcoholics from non-alcoholics; however, long-term heavy drinking does have a few recognizable effects on the body, including:

Macrocytosis (enlarged MCV)1
Elevated GGT²
Moderate elevation of AST and ALT and an AST: ALT ratio of 2:1.
High carbohydrate deficient transferrin (CDT)
However, none of these blood tests for biological markers are as sensitive as screening questionaires.

Effects of long term alcohol misuse
Main article: Long-term effects of alcohol
The primary effect of alcoholism is to encourage the sufferer to drink at times and in amounts that are damaging to physical health. The secondary damage caused by an inability to control one’s drinking manifests in many ways. Alcoholism also has significant social costs to both the alcoholic and their family and friends. Alcoholics have a very high suicide rate and studies show between 8% and 21% of alcoholics commit suicide. Alcoholism also has a significant adverse impact on mental health. The risk of suicide among alcoholics has been determined to be 5,080 times that of the general public.[32]

Physical health effects
It is common for a person suffering from

alcoholism to drink well after physical health effects start to manifest. The physical health effects associated with alcohol consumption may include cirrhosis of the liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, increased chance of cancer, nutritional deficiencies, sexual dysfunction, and death from many sources. Severe cognitive problems are not uncommon in alcoholics. Approximately 10% of all dementia cases are alcohol related making alcohol the 2nd leading cause of dementia.[33]

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Mental health effects
Long term misuse of alcohol can cause a wide range of mental health effects. Alcohol misuse is not only toxic to the body but also to brain function and thus psychological well being can be adversely affected by the long-term effects of alcohol misuse. Psychiatric disorders are common in alcoholics, especially anxiety and depression disorders, with as many as 25% of alcoholics presenting with severe psychiatric disturbances. Typically these psychiatric symptoms caused by alcohol misuse initially worsen during alcohol withdrawal but with abstinence these psychiatric symptoms typically gradually improve or disappear altogether.[34] Psychosis, confusion and organic brain syndrome may be induced by chronic alcohol abuse which can lead to a misdiagnosis of major mental health disorders such as schizophrenia.[35] Panic disorder can develop as a direct result of long term alcohol misuse. Panic disorder can also worsen or occur as part of the alcohol withdrawal syndrome.[36] Chronic alcohol misuse can cause panic disorder to develop or worsen an underlying panic disorder via distortion of the neurochemical system in the brain.[37]

The co-occurrence of major depressive disorder and alcoholism is well documented.[38][39][40] Among those with comorbid occurrences, a distinction is commonly made between depressive episodes that are secondary to the pharmacological or toxic effects of heavy alcohol use and remit with abstinence, and depressive episodes that are primary and do not remit with abstinence. Additional use of other drugs may increase the risk of depression in alcoholics.[41] Depressive episodes with an onset prior to heavy drinking or those that continue in the absence of heavy drinking are typically referred to as “independent” episodes, whereas those that appear to be etiologically related to heavy drinking are termed “substance-induced”.[42][43][44]

Social effects
The social problems arising from alcoholism can be massive and are caused in part due to the serious pathological changes induced in the brain from prolonged alcohol misuse and partly because of the intoxicating effects of alcohol.[33] Being drunk or hung over during work hours can result in loss of employment, which can lead to financial problems including the loss of living quarters. Drinking at inappropriate times, and behavior caused by reduced judgment, can lead to legal consequences, such as criminal charges for drunk driving or public disorder, or civil penalties for tortious behavior. An alcoholic’s behavior and mental impairment while drunk can profoundly impact surrounding family and friends, possibly leading to marital conflict and divorce, or contributing to domestic violence. This can contribute to lasting damage to the emotional development of the alcoholic’s children, even after they reach adulthood. The alcoholic could suffer from loss of respect from others who may see the problem as self-inflicted and easily avoided.

Alcohol withdrawal
Main article: Alcohol withdrawal syndrome
Alcohol withdrawal differs significantly from most other drugs in that it can be directly fatal. For example it is extremely rare for heroin withdrawal to be fatal. When people die from heroin or cocaine withdrawal they typically have serious underlying health problems which are made worse by the strain of acute withdrawal. An alcoholic, however, who has no serious health issues, has a significant risk of dying from the direct effects of withdrawal if it is not properly managed. Drugs which have a similar mechanism of action to alcohol also have a similar risk of causing death during withdrawal, including barbiturates and benzodiazepines.

Alcohol’s primary effect is the increase in stimulation of the GABAA receptor, promoting central nervous system depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in tolerance and physical dependence. Thus when alcohol is stopped, especially abruptly, the person’s nervous system suffers from uncontrolled synapse firing. This can result in symptoms that include anxiety, life threatening seizures, delirium tremens and hallucinations, shakes and possible heart failure.

Acute withdrawal symptoms tend to subside after 1 – 3 weeks. Less severe symptoms (e.g. insomnia and anxiety) may continue as part of a post withdrawal syndrome gradually improving with abstinence for a year or more. Withdrawal symptoms begin to subside as the body and central nervous system makes adaptations to reverse tolerance and restore GABA function towards normal. Other neurotransmitter systems are involved, especially glutamate and NMDA.

Treatments
Treatments for alcoholism are quite varied because there are multiple perspectives for the condition itself. Those who approach alcoholism as a medical condition or disease recommend differing treatments than, for instance, those who approach the condition as one of social choice.

Most treatments focus on helping people discontinue their alcohol intake, followed up with life training and/or social support in order to help them resist a return to alcohol use. Since alcoholism involves multiple factors which encourage a person to continue drinking, they must all be addressed in order to successfully prevent a relapse. An example of this kind of treatment is detoxification followed by a combination of supportive therapy, attendance at self-help groups, and ongoing development of coping mechanisms. The treatment community for alcoholism typically supports an abstinence-based zero tolerance approach; however, there are some who promote a harm-reduction approach as well.[16]

Effectiveness
When considering the effectiveness of treatment options, one must consider the success rate based on those who enter a program, not just those who complete it. Since completion of a program is the qualification for success, success among those who complete a program is generally near 100%. It is also important to consider not just the rate of those reaching treatment goals but the rate of those relapsing. Results should also be compared to the roughly 5% rate at which people will quit on their own.[45] A year after completing a rehab program, about a third of alcoholics are sober, an additional 40 percent are substantially improved but still drink heavily on occasion, and a quarter have completely relapsed.[46]

Detoxification
Main article: Alcohol detoxification
Alcohol detoxification or ‘detox’ for alcoholics is an abrupt stop of alcohol drinking coupled with the substitution of drugs that have similar effects to prevent alcohol withdrawal.

Detoxification treats the physical effects of prolonged use of alcohol, but does not actually treat alcoholism. After detox is complete, relapse is likely without further treatment. These rehabilitations (or ‘rehabs’) may take place in an inpatient or outpatient setting.

Group therapy and psychotherapy

A regional service center for Alcoholics Anonymous.After detoxification, various forms of group therapy or psychotherapy can be used to deal with underlying psychological issues that are related to alcohol addiction, as well as provide relapse prevention skills.

The mutual-help group-counselin

g approach is one of the most common ways of helping alcoholics maintain sobriety. Many organizations have been formed to provide this service. Alcoholics Anonymous was the first group, and has more members than all other programs combined. Some of the others include LifeRing Secular Recovery, Rational Recovery, SMART Recovery, and Women For Sobriety.

Rationing and moderation
Rationing and moderation programs such as Moderation Management and DrinkWise do not mandate complete abstinence. While most alcoholics are unable to limit their drinking in this way, some return to moderate drinking. A 2002 U.S. study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed that 17.7% of individuals diagnosed as alcohol dependent more than one year prior returned to low-risk drinking. However, this group showed fewer initial symptoms of dependency.[47] A follow-up study, using the same NESARC subjects that were judged to be in remission in 2001-2002, examined the rates of return to problem drinking in 2004-2005. The major conclusion made by the authors of this NIAAA study was “Abstinence represents the most stable form of remission for most recovering alcoholics”.[48]

Medications
A variety of medications may be prescribed as part of treatment for alcoholism.

Antabuse (disulfiram) prevents the elimination of acetaldehyde, a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many hangover symptoms from alcohol use. The overall effect is severe discomfort when alcohol is ingested: an extremely fast-acting and long-lasting uncomfortable hangover. This discourages an alcoholic from drinking in significant amounts while they take the medicine. A recent 9-year study found that incorporation of supervised disulfiram and a related compound carbamide into a comprehensive treatment program resulted in an abstinence rate of over 50%.[49]
Naltrexone is a competitive antagonist for opioid receptors, effectively blocking our ability to use endorphins and opiates. Alcohol releases endorphins, hence when naltrexone is in the body drinkers no longer get any pleasure from consuming alcohol. Naltrexone is used in two very different forms of treatment. The first treatment uses naltrexone to decrease cravings for alcohol and encourage abstinence. The other treatment, called pharmacological extinction, combines naltrexone with normal drinking habits in order to reverse the endorphin conditioning that causes alcohol addiction. This results in a reduced desire to drink that persists after naltrexone use is discontinued, as long as the patient always takes naltrexone before drinking.
Naltrexone comes in two forms. Oral naltrexone (originally but no longer available as the brand ReVia) is a pill that must be taken one hour before drinking to be effective. Vivitrol is a time-release formulation that is injected in the buttocks once a month.
Acamprosate (also known as Campral) is thought to stabilize the chemical balance of the brain that would otherwise be disrupted by alcoholism. The Food and Drug Administration (FDA) approved this drug in 2004, saying “While its mechanism of action is not fully understood, Campral is thought to act on the brain pathways related to alcohol abuse… Campral proved superior to placebo in maintaining abstinence for a short period of time…”[50] The COMBINE study was unable to demonstrate efficacy for Acamprosate.[51]
Topiramate (brand name Topamax), a derivative of the naturally occurring sugar monosaccharide D-fructose, has been found effective in helping alcoholics quit or cut back on the amount they drink. In one study heavy drinkers were six times more likely to remain abstinent for a month if they took the medication, even in small doses.[52][53] In another study, those who received topiramate had fewer heavy drinking days, fewer drinks per day and more days of continuous abstinence than those who received the placebo.[54] Evidence suggests that topiramate antagonizes excitatory glutamate receptors, inhibits dopamine release, and enhances inhibitory gamma-aminobutyric acid function. A 2008 review of the effectiness of topiramate concluded that the results of published trials are promising, however at this time, data are insufficient to support using topiramate in conjunction with brief weekly compliance counseling as a first-line agent for alcohol dependence. [55]

Dual addictions
The AMA definition of alcoholism refers to a disease entity involving the use of alcohol and any cross-tolerant sedative-hypnotic, including barbiturates and benzodiazepines. As discussed above, the DSM-IV definition of alcohol dependence refers to alcohol only, and DSM-IV uses sedative dependence to refer to the disease entity involving non-alcohol sedative agents. Alcoholics may also require treatment for other psychotropic drug addictions. The most common dual addiction in alcohol dependence is a benzodiazepine dependence with studies showing 10 – 20% of alcohol dependent individuals having problems of dependence and/or misuse problems of benzodiazepines. Note that using alcoholism’s definition, there is no dual addiction if one uses both alcohol and any solid sedative. Dependence on other sedative hypnotics such as zolpidem and zopiclone as well as opiates also occurs as well as illegal drugs. Benzodiazepine withdrawal can like alcohol be medically severe and include the risk of psychosis and seizures if not managed properly.[56] Benzodiazepine dependency requires careful reduction in dosage to avoid a serious benzodiazepine withdrawal syndrome and health consequences. Benzodiazepines have the problem of increasing cravings for alcohol in problem alcohol consumers. Benzodiazepines also increase the volume of alcohol consumed by problem drinkers.[57]

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Women and alcoholism
Alcoholism has a higher prevalence among men, though in recent decades, the proportion of female alcoholics has increased.[58] It is important to articulate the different biological and social ways alcoholism manifests in women in order to understand barriers to treatment and effective recovery strategies.

Biological differences and physiological effects
Biologically, women have symptom profiles from their alcohol use that differ in important ways from men. They experience a telescoping of physiological effects from alcohol use. Equal dosages of alcohol consumed by men and women generally result in women having higher blood alcohol concentrations (BACs).[59] This can be attributed to many reasons, the main being that women have less body water than men. A given amount of alcohol, therefore becomes more highly concentrated in a woman’s body. Besides this fact, women also become more intoxicated, which is due to different hormone release.[60]

Women develop long-term complications of alcohol dependence more rapidly than do alcoholic men. Additionally, women have a higher mortality rate from alcoholism than men.[61] Examples of long term complications include brain, heart, and liver damage[62] and an increased risk for breast cancer. Additionally, heavy drinking over time has been found to have a negative effect on reproductive functioning in women. This results in reproductive dysfunction such as anovulation, decreased ovarian mass, irregular menses, amenorrhea, luteal phase dysfunction, and early menopause.[63]

Psychological and emotional effects
Psychiatric disorders are generally more prevalent among those with alcohol disorders. This is true for both men and women, however the disorders differ depending on gender. Women who have alcohol-use disorders have co-occurring psychiatric diagnosis such as major depression, anxiety, panic disorder, bulimia, post-traumatic stress disorder (PTSD), or borderline personality disorder. Men wi

th alcohol-use disorders more often have co-occurring diagnosis of narcissistic and antisocial personality disorders, bipolar disorder, schizophrenia, impulse disorders and attention deficit/ hyperactivity disorder.[64]

Women with alcoholism are also more likely to have a history of physical or sexual assault, abuse and domestic violence than those in the general population.[65] This trauma can lead to higher instances of PTSD, depression, anxiety, and a greater dependence on alcohol.

Societal barriers to treatment
Attitudes and social stereotypes about women and alcohol can create barriers to the detection and treatment of female alcohol abusers. Such beliefs stigmatize women who drink by characterizing them as “both generally and sexually immoral” or the “fallen women.” Fear of stigmatization may lead women to deny that they are suffering from a medical condition, to hide their drinking, and to drink alone. This pattern, in turn, leads family, physicians, and others to be less likely to suspect that a woman they know is an alcoholic.[66]

In contrast, attitudes and social stereotypes about men and alcohol can lower barriers to the detection and treatment of male alcohol abusers. Such beliefs reward men who drink by characterizing them as “both generally and sexually moral” or the “risen men.” Reduced fear of stigma may lead men to admit that they are suffering from a medical condition, to publicly display their drinking, and to drink in groups. This pattern, in turn, leads family, physicians, and others to be more likely to suspect that a man they know is an alcoholic.

Women also tend to have a greater fear that the negative implications from the stigma will reflect poorly on their families. This may also keep them from seeking help.[67]

Therefore, men also tend to have less fear that the negative implications from the stigma will reflect poorly on their families. This may encourage them to seek help.

Implications for treatment
Research has indicated a lack of adequate training for practitioners both in problematic alcohol use in general, and in relation to women’s issues.[68] The complexity of alcohol use disorders, particularly with gender-related issues, indicates that the need for practitioners’ knowledge, insight and compassion is enormous.[69] Better education and awareness surrounding the gender implications of alcoholism will help care providers to adequately treat women who suffer from alcoholism. Early intervention will also increase the probability of recovery.

Societal impact
The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to society, for example, money due to lost labor-hours, medical costs, and secondary treatment costs. Alcohol use is a major contributing factor for head injuries, motor vehicle accidents, violence, and assaults. Beyond money, there is also the pain and suffering of the individuals besides the alcoholic affected. For instance, alcohol consumption by a pregnant woman can lead to Fetal alcohol syndrome,[70] an incurable and damaging condition.[71]

Estimates of the economic costs of alcohol abuse, collected by the World Health Organization, vary from one to six per cent of a country’s GDP.[72] One Australian estimate pegged alcohol’s social costs at 24 per cent of all drug abuse costs; a similar Canadian study concluded alcohol’s share was 41 per cent.[73]

A study quantified the cost to the UK of all forms of alcohol misuse as £18.5–20 billion annually (2001 figures).[17][74]

Stereotypes

Depiction of a wino or town drunkStereotypes of alcoholics are often found in fiction and popular culture. The ‘town drunk’ is a stock character in Western popular culture.

Stereotypes of drunkenness may be based on racism or xenophobia, as in the depiction of the Irish as heavy drinkers.[75][76] In Australia, Canada, and the United States, Aboriginal people have similarly been stereotyped as alcoholics.

On the other hand, studies by social psychologists Stivers and Greeley[77] attempt to document the perceived prevalence of high alcohol consumption amongst the Irish in America.

Alcohol related crime
See also: drug-related crime
Of the adult population at least three- fourths are drinkers, so about 6 percentage of the total group. The alcoholism rate runs about 8 percent to 12.Many reports state that about 73 percent of felonies are alcohol-related. A survey shows that in about 67 percent of child-beating cases, 41 percent of forcible rape cases, 80 percent of wife-battering, 72 percent of stabbings, and 83 percent of homicides, either the attacker or the victim or both had been effected by drinking. If we include alcohol abusers the best estimate is 10.5 of the working Americans.[78]–Cassie100 (talk) 15:02, 22 June 2009 (UTC)

In film and literature
In modern times, the recovery movement has led to more realistic depictions of problems that stem from heavy alcohol use. Authors such as Charles R. Jackson and Charles Bukowski describe their own alcohol addiction in their writings. The disjoined narrative of Patrick Hamilton’s Hangover Square reflects the alcoholism of its central character. A famous depiction of alcoholism, and the psychology of an alcoholic, is in Malcolm Lowry’s widely acclaimed novel Under the Volcano, which details the final day of the British consul Geoffrey Firmin on the Day of the Dead in 1939 Mexico and his choice to continue his extreme alcohol consumption instead of returning to the wife he loves.

Films like Bad Santa, Days of Wine and Roses, My Name is Bill W., Withnail and I, Arthur, Leaving Las Vegas, Shattered Spirits and The Lost Weekend, chronicle similar stories of alcoholism.

Politics and public health
Because alcohol use disorders are perceived as impacting society as a whole, governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism. The World Health Organization, the European Union and other regional bodies are working on alcohol action plans and programs.

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Some people living with grief find it useful to learn that their experience is typical. This does not only help them feel less alone with their feelings, but also offers hope that they will be able to survive this terrible experience. Coping with feelings of intense loss is not easy, but it is possible.

What is “Normal”?

When it comes to handling intense emotions, nearly everything is normal. Everyone handles shock and pain in his or her own way. For example, it is perfectly normal to:

Cry, or not. Some people worry that crying is a sign of weakness that could make them a “burden” on those who might worry about them. Others worry that not crying shows they are not truly missing their loved ones. Neither one is true; crying helps some but not others.

Experience unexpected “triggers.” Sometimes mourning people seem to turn a corner and begin to feel better. Then, something reminds them of their loss and they are suddenly in pain again. This is a normal experience that should lessen with time, but it may take a long time.

Feel irrational anger. It is human nature to look for someone or something to blame for our suffering. Sometimes there is no logical target for our anger, so we begin to focus on something that cannot really be to blame. As long as this anger does not interfere with your ability to function, it is perfectly normal.

Of course, the fact that the pain you are feeling is typical does not make it any easier to bear. While you wait for things to improve, be sure to take care of yourself. Do not be afraid to rely on friends and family for support, and do not forget to eat well and exercise.

When Grief Will Not Lift

It is important to note that grief can cross a line into clinical depression, at which point professional care may be needed. Anyone who is experience intense feelings of hopelessness, an inability to face daily tasks, or thoughts of suicide needs to contact a doctor right away.

Grief can be compounded when surviving loved ones know their loss could have been avoided if a third party had been more attentive or careful.

Many deaths took place when I was active with those web pages. I learnt a lot during that period. The main lesson was that grief is not logical. To die is certain and we all know that but when somebody very dear to us dies, no amount of logic helps. One must shed tears to heal.

I have interacted with many persons with broken relationships on message boards. I observed that most of these people were ok for some days but went back to depression and pain soon. You could not believe that a person, who was advising others a few days back, has himself or herself broken down again. This was cyclic in many people. Again I learnt a lesson that grief and bitterness of having been left by a loved one do not go away soon. The inner mind carries all emotions that defy any logic that the outer mind proposes.

What is the remedy? I have found that another who is also grieving best understands a person who is grieving. If a grieving person talks to a healthy individual, no amount of interaction helps. But if he/she talks to someone who is also facing grief, understanding is very fast.