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酒精和心理健康

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

[8] Issa FG, et al. Alcohol, snoring and sleep apnea. J Neurol Neurosurg Psychiatry. 1982;45(4):353

[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.

[20] Zaridze D, et al. Alcohol and cause-specific mortality in Russia: a retrospective case-control study of 48,557 adult deaths. Lancet. 2009; ;373(9682):2201.

[21] Thun MJ, et al. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med. 1997;337(24):1705.

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