酒精和心理健康
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世界卫生组织(WHO)估计,每年全球发生的疾病和损伤中有5.1%是由于酒精导致的。[1]在中国,根据世界卫生组织2010年的数据显示,有9.3%的成年男性发生了酒精中毒性精神障碍,其中24%的人有刚超过15岁即参与大量酗酒的经历。[2]这些数字可以和美国的数据进行比较。[3]
酒精会对心理健康产生深远的影响。[4]本文旨在探讨目前出现的一些关于酒精和心理健康的临床常见问题。
酗酒的定义
在谈论酒精引起的消耗性疾病问题上有许多不同的措辞,其中一些显得更有临床意义(如酒精中毒性精神障碍[5]),其他的则更口语化(如酒精中毒)。在本文中,一般概念是指不恰当的酒精滥用(也被称作酗酒),通常包括控制饮酒问题,酒精成瘾问题,尽管生活各个方面(人际关系、法律、医疗问题,等等)都受影响也坚持使用酒精,以及思维受到扭曲的严重症状(否认是最常见的一种表现)。[6]
酒精对睡眠的影响
很多人认为饮酒有助于睡眠。然而,医学研究清楚表明,尽管酒精能让你更快睡着,长期饮酒则会导致睡眠质量变差。饮酒会导致睡眠不安稳(即睡眠质量低)、频繁惊醒(通常称作失眠)和快速眼动睡眠时间减少。[7]另外,如果是已经有睡眠障碍的人(例如阻塞性睡眠呼吸暂停),酒精会加重障碍症状。[8],[9]我推荐一个来自梅奥诊所网站的值得信赖的睡眠技巧分享,详见下面的脚注。[10]
酒精和抑郁症
抑郁症可以由酒精中毒和戒断引起(有时称作“继发性抑郁症”)。 [11]有酗酒问题的人更容易发生自残和自杀行为。[12]事实上,近三分之一的抑郁症患者有酗酒问题。[13]因此,可以概括的说,患抑郁症的人很容易过度饮酒,而有酗酒问题的人也更有可能患上抑郁症。
酒精和焦虑症
物质滥用问题在所有类型的焦虑症中都很常见。焦虑情绪和酒精之间的关系是复杂的。对于一些人来说,是焦虑情绪大大增加了其滥用药物或酒精的风险。对于其他人,则是因物质滥用放大和引起了焦虑症状。物质滥用和广泛性焦虑障碍共同存在的概率是惊人的,在样本数据中超过了50%。[14]高度的酒精滥用还会导致恐慌症[15]和创伤后精神紧张性障碍(即PTSD,在一般人群[16]和军事人员[17]中都会发生)。
酒精和营养
酗酒就是“浪费热量”,意指即使你总的热量摄入量保持正常,但你的身体可能还是达不到维生素和营养的需要从而无法保持健康。这对有肝脏疾病的人来说尤其如此。[18]在重度酗酒的成年人中,最常见的就是缺乏硫胺素(维生素B1)、吡哆醇(维生素B6)和叶酸。[19]营养不良往往和重要的发病率及致死率联系在一起。
酒精引起的相关疾病
酒精可导致许多严重的健康问题,包括高血压、肝炎、胰腺炎和心脏病。[20]虽然有一些证据表明,适度饮酒可以保护心脏,尤其是能降低60岁以下人群患心血管疾病的风险,大量饮酒则与致使死亡率上升的各种原因有关。[21]
关键信息
如果您或您的家人有酗酒问题,为您自身和您的家庭考虑,您应该联系您的医生咨询相应的治疗问题。
[1] World Health Organization. Global status report on alcohol and health 2014. Accessed August 29, 2014: http://apps.who.int/iris/bitstream/10665/112736/1/9789240692763_eng.pdf?ua=1
[2] World Health Organization. Global status report on alcohol and health 2014. Accessed August 29, 2014: http://apps.who.int/iris/bitstream/10665/112736/1/9789240692763_eng.pdf?ua=1
[3] Hasin DS, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2007;64(7):830
[4] Drummond C, et al. (2011). Alcohol-use disorders: The NICE guideline on diagnosis, assessment and management of harmful drinking and alcohol dependence. Clinical Guideline 115. London:National Collaborating Centre for Mental Health, NICE.
[5] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
[6] Gold, M, et al. Alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, adverse consequences, and diagnosis. UpToDate. Accessed August 29, 2014: http://www.uptodate.com/contents/alcohol-use-disorder-epidemiology-pathogenesis-clinical-manifestations-adverse-consequences-and-diagnosis
[7] Here is one useful website from the United States’ National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/alcohol-health
[9] National Sleep Foundation. People with Apnea More Vulnerable to Effects of Alcohol. Accessed online August 29, 2014: http://sleepfoundation.org/sleep-news/people-apnea-more-vulnerable-effects-alcohol
[10] Mayo Clinic. Sleep Tips. Accessed online August 29, 2014: http://www.mayoclinic.org/healthy-living/adult-health/in-depth/sleep/art-20048379?pg=1
[11] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013
[12] Royal College of Psychiatrists. Alcohol and Depression. Accessed online August 29, 2014: http://www.rcpsych.ac.uk/mentalhealthinfoforall/problems/alcoholanddrugs/alcoholdepression.aspx
[13] Royal College of Psychiatrists. Alcohol and Depression. Accessed online August 29, 2014: http://www.rcpsych.ac.uk/mentalhealthinfoforall/problems/alcoholanddrugs/alcoholdepression.aspx
[14] Grant BF, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004;61(8):807
[15] Regier DA, et al. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA. 1990;264(19):2511.
[16] Kessler RC, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048.
[17] Kessler RC, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048.
[18] Bunout D. Nutritional and metabolic effects of alcoholism: their relationship with alcoholic liver disease. Nutrition. 1999 Jul;15(7-8):583-9.
[19] McClain CJ, et al. Alcoholic liver disease and malnutrition. Alcohol Clin Exp Res. 2011 May;35(5):815-20. Epub 2011 Feb 1.
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