madyavyasanita

Alcoholism
vargeekaran evam baahya saadhan
King Alcohol and his Prime Minister.jpg
"king alkohal aur uske prime mineestar" sirka 1820
aaiseedi-10 F10..2
aaiseedi-9 303
medalaain plas alcoholism
M.iesaech D000437

madyavyasanita ko madya nirbharata[1][2] ke roop mein bhi jaana jaata hai, jo niryogyakaari vyasanakaari vikaar hai. sharaab arthaat alkohal peenevaale ki sehat, sambandhon aur saamaajik haisiyat par iske nakaaraatmak prabhaav ke baavajood jabaradast aur aniyantrit sharaab sevan dvaara iski chaaritrik visheshata bataayi gayi hai. anya maadak padaarthon ki lat ki tarah, chikitsaashaastr mein madyavyasanita ko chikitsa yogya beemaari ke roop paribhaashit kiya gaya hai.[3] "madyavyasanita" shabd ka prayog vyaapak roop se 1849 mein maignas has dvaara kiya gaya hai, lekin aushadhishaastr mein 1960 ke dashak mein deeesaem III (DSM III) mein is shabd ki jagah "sharaab ka apaprayog" aur sharaab par nirbharata" jaisi shabdaavali ka prayog kiya gaya hai.[4] isi prakaar 1979 mein vishv svaasthya sangathan ki ek visheshagya samiti ne iski naidaanik sthiti ko dekhte hue madyavyasanita shabd ke upayog ko pasand naheen kiya aur ise "sharaab nirbharata sindrom" ki shreni mein rakhe jaane ko vareeyata di.[5] 19veen aur 20veen shataabdi ki shurooaat mein, "madyavyasanita" ya piykkadpan shabd ke chalan se pehle sharaab par nirbharata, madyonmaad kahalaati thi.[6]

baharahaal, madyavyasanita ko jaivik prakriya ka samarthan anishchit hai, haalaanki iske jokhim kaarak saamaajik vaataavaran, tanaav,[7] maanasik svaasthya, aanuvanshik pravrutti, umr, jaateeya samooh aur sex hain.[8][9] deerghakaalik sharaab ka apaprayog ya durupayog dimaag ke shaareerik kriya mein parivartan karta hai, jaise ki isse sahanasheelata aur shaareerik roop se nirbharata prabhaavit hoti hai. aise mastishkeeya raasaayanik parivartan sharaab sevan ko tyaagane ki madyajanya baadhyakaari asamarthata ko banaaye rakhate hai aur yeh sharaab peena band karne par alakohal tyaag sindrom mein parivrtit ho jaata hai.[10] sharaab mastishk sahit shareer ke lagbhag har ang ko nuksaan pahunchaati hai, kyonki sanchayi vishaila prabhaav lambe samay se sharaab ke apaprayog ko prabhaavit karta hai, chikitsa se lekar maanasik vikaaron se peedit hona sharaab ke jokhim hain.[11] madyavyasanita sharaabi aur uske parijanon ki samaajik pratishtha ke liye gahra dhakka hai.[12][13]

madyavyasanita sahanasheelata, nirliptata aur atyadhik maatra mein sharaab sevan ki chakreeya maujoodagi hai; uske ya usaki sehat ko honevaale nuksaan ke prati jaagruk hone ke baavajood peenevaala baadhyakaari ‍amadyapaan ko niyantrit karne mein asamarth hota hai, yeh is baat ka sanket hai ki vah shakhs piykkad ho sakta hai.[14] prashnaavali aadhaarit screening madyavyasanita samet haanikaarak roop se peene ke pairtan ka pata lagaane ka tareeka hai. [15] kisi shakhs ko sharaab peene se door rakhane ke liye vishharan (alakohal ditauksifikeshan) kiya jaata hai, aamtaur par nirliptata lakshanon ko vyavasthit karne ke liye pratikool-sahanasheel aushadhi udaaharan ke liye beinjodaayajepins se kiya jaata hai.[16] samooh ya swayam sahaayata samooh upachaar jaise chikitsakeeya dekhbhaal ke baad aamtaur par sharaab se parahej banaaye rakhane ki aavashyakta hai.[17][18] aksar, sharaabi anya maadak padaarthon ke bhi aadi hote hain, jyaadaatar beinjodaayajepins ke, jismein atirikt chikitsakeeya upachaar ki aavashyakta hoti hai.[19] sharaabi hone mein purushon ki apeksha sharaabi mahilaaen sharaab ke shaareerik, dimaagi aur maanasik haanikaarak prabhaav aur saamaajik kalank ke prati adhik samvedansheel hoti hain.[20][21] vishv svaasthya sangathan ka anumaan hai ki duniya bhar mein 140 million sharaabi hain.[22][23]

anukram

vargeekaran aur shabdaavali

sharaab ka durupayog, samasyaajanit upayog, apaprayog aur bhaari maatra mein upayog ka arth sharaab ka anuchit upayog hai, jo sharaabi ko shaareerik, samaajik ya naitik nuksaan pahuncha sakte hain. [24] the daaetari gaaidalaains for amerikns dvaara purushon ke liye maadak peya pratidin do se adhik naheen aur mahilaaon ke liye ek maadak peya pratidin se adhik na lene ko sharaab ke udaaravaadi upayog ke roop mein paribhaashit kiya gaya hai.[25]

"madyavyasanita" shabd ka istemaal aam roop se kiya jaata hai, lekin ise bahut hi kharaab tareeke se paribhaashit kiya jaata hai. madyavyasanita ko dablyooechao (WHO) ne "lambe samay se lagaataar upayog aur parivrti arth" ke roop mein paribhaashit kiya hai aur is shabd ke istemaal ka 1979 mein dablyooechao visheshagya sama‍aiti ne virodh kiya. the big book (alkohaliks enonims dvaara) kehta hai ki ek baar koi shakhs madyap ho jaata hai, vah hamesha madyap (sharaabi) hi rahata hai, lekin is sandarbh mein "madyap" shabd ka arth kya hai, ise paribhaashit naheen kiya gaya hai. 1960 mein bill dablyoo. ne kaha:

ham madyavyasanita ko kabhi bhi beemaari naheen kehte hain, kyonki takaneeki taur par kaha jaae to iski ginti kisi beemaari mein naheen hoti hai.

udaaharan ke liye, dil ki beemaari jaisi koi cheej naheen hoti hai. balki ismein hrudaya ke bahut saare alag kism ke ya inke sanyojit vikaar hote hain. madyavyasanita isi tarah ki koi cheej hai. isliye ham madyavyasanita ko beemaari kah kar chikitsa vyavasaaya ke saath kuchh galat naheen karna chaahate hain. isliye ham hamesha ise rugnata, ya vyaadhi kah kar - kaheen adhik surakshit shabd ka upayog karte hain.[26]

peshevar aur anusandhaan sandarbhon mein, "madyavyasanita" shabd mein kabhi-kabhi sharaab ka apaprayog aur sharaab par nirbharata donon ko shaamil kar liya jaata hai.[27] aur ise kabhi-kabhi sharaab par nirbharata ke samaan maana jaata hai.

manovijnyaaan aur manorog vigyaan mein, deeesaem (DSM) bahut hi saamaanya vaishvik maanak hai, jabki chikitsa mein, aaiseedi (ICD) maanak hai. in logon ne jin shabdon ki sifaarish ki hai, ve ek samaan hain, lekin abhinn naheen hain.

WHO's ICD-10 (aaiseedi-10) "sharaab ka haanikaarak upayog" aur "sharaab nirbharata sindrom" paribhaashaaen DSM-IV (deeesaem-IV) ke hi samaan hain. vishv svaasthya sangathan ne madyavyasanita ke bajaae sharaab nirbharata sindrom shabd ka upayog kiya hai.[5] 1992 ke dashak mein pehli baar aaiseedi -10 (ICD-10) mein "haanikaarak upayog" ki avadhaarana (durupayog ke vipreet) ka upayog nirbharata ke abhaav nuksaan ko kam se kam karke bataane ke liye kiya gaya tha.[4] madyapaan shabd aaiseedi (ICD) ke aaiseedi-8/aaiseedeee-9 (ICD-8/ICDA-8) aur aaiseedi-9 (ICD-9) ke beech se nikaal diya gaya.[31]

shabd mein aparishuddhi nihit hone ke baavajood, "madyavyasanita" shabd ka jab saamana ho to iski vyaakhya kis tarah ki jaani chaahiye, ise paribhaashit karne ka prayaas kiya gaya hai. 1992 mein ise enaseeedeedi (NCADD) aur eesaeem (ASAM) dvaara "ek praathamik, jeern beemaari ke roop mein ise paribhaashit karke iska chitran ati paan ke niyantran ke ayogya ho, drag sharaab ke nashe mein dhut, pratikool parinaam ke baavajood sharaab ka upayog aur soch mein vikruti ki tarah kiya gaya."[32] 1999 se "madyavyasanita" ko MeSH mein pravisht mili hui hai aur iski paribhaasha 1992 ke sandarbh mein hai. [33]

shabd vyutpatti

1904 ke vigyaapan mein ek beemaari ke roop mein sharaab ka varnan.

iske madyavyasanita ke naam se jaane jaane se pehle aitihaasik roop se 1819 mein ek jarman chikitsak dau॰ si. dabalyoo. hufelaind dvaara ise madyonmaad naam diya gaya hai.[34][35] "madyavyasanita" shabd ka upayog pehli baar 1849 mein ek sveedish chikitsak Magnus has dvaara vyavasthit pratikool prabhaavon ka varnan karte hue kiya gaya.[36]

ee ne madyavyasanita ka varnan ek aisi beemaari ke roop mein kiya hai jo shaareerik elarji aur maanasik junoon se sambandhit hai.[37]:p.23 [38] dhyaan rahe ki "elarji" ki paribhaasha ka upayog is sandarbh mein jis tarah kiya gaya vah aadhunik chikitsa mein us tarah naheen kiya gaya hai.[39] Doctor aur vyasan visheshagya dau॰ William di. silkavarth M. di. ee (AA) ki or se likhte hain ki "sharaabi maanasik niyantran se pare (shaareerik) prabal laalasa se grast hota hai."[37] :XXVI

1960 mein E. maurtan jelinek dvaara kiye gaya adhyayan mein aadhunik beemaari mein sharaab ke siddhaant ko iski jad mein dekha gaya hai.[40] jelinek ki paribhaasha madyapaan shabd ke upayog ka virodh karti hai, khaastaur par vahaan, jahaan praakrutik itihaas ka vishisht maamala ho. tab se lekar ab tak sharaab ki aadhunik chikitsakeeya paribhaasha ko kai baar sanshodhit kiya gaya hai. vartamaan samay mein American medical association madyavyasanita shabd ka upayog khaastaur par jeern praathamik beemaari ke sandarbh mein karta hai.[41]

is maamale mein alpasankhyak rai madyavyasanita ko beemaari kehne ke khilaaf hai, harabart fingaret aur staiton pile ullekhaneeya roop se madyavyasanita ko beemaari maanane ke khilaaf hain. jab kabhi sharaab peene ke nakaaraatmak prabhaav ki charcha ki gayi hai, tab beemaari ke model ke aalochakon ne "bhaari maatra mein peene" shabd ka upayog kiya hai.

sanket aur lakshan

A diagram showing the mostly bad effects of consuming a large amount of alcohol compared to the good effects of a small to moderate amount.
ithenaul ke sambhav deerghakaalik prabhaav se kuchh ek vyakti ka vikaas ho sakta hai. iske atirikt, garbhavati mahilaaon mein sharaab bhroon se sharaab sindrom ho sakta hai.

alkohal ke liye badhti sahyata aur us par badhti shaareerik nirbharata dvaara madyavyasanita arthaat piykkadpan ki visheshata ka chitran hota hai, jo vyakti ki alkohal khapat ko niyantrit karne ki kshamata par prabhaav daalata hai. maana jaata hai ki ye visheshataaen sharaab peene ki sharaabi ki kshamata mein vighn daalne ki bhoomika ada karti hain.[10] madyavyasanita maanasik svaasthya par pratikool prabhaav daalati hai, isse manovaigyaanik vikaar paida hote hain aur aatmahatya ka jokhim badh jaata hai.[42][43]

shaareerik lakshan

deerghakaalik sharaab ke apaprayog se anek prakaar ke shaareerik rogon ke lakshan saamane aa sakte hain, inmein yakrut ka sirosis, agnaashayakop, mirgi, poleenyooropaithi, piykkad manobhransh, hradaya rog, poshan sambandhi dosh aur yaun dushkriya shaamil hain, jo antat: ghaatak ho sakte hain. anya bhautik prabhaavon mein hradayavaahini rog viksit hone ke jokhim mein vruddhi, paachanatantr mein gadbad, madyajanya yakrut rog aur Cancer shaamil hain. lagaataar sharaab peene se keindreeya tantrika tantr aur paridheeya tantrika tantr ko kshati pahunch sakti hai.[44][45]

mahilaaon mein purushon ki apeksha bahut teji se sharaab nirbharata ki deerghakaalik jatiltaaon ka vikaas hota hai. iske atirikt, madyavyasanita se purushon ki tulana mein mahilaaon ki mrutyu dar adhik hai.[20] jatiltaaon ki deerghaavadhi ke udaaharanon mein mastishk, hrudaya aur yakrut ki kshati[21] shaamil hain aur stan Cancer ka khtara bhi badh jaata hai. iske atirikt, kaafi samay se bahut adhik sharaab peene ki aadat se mahilaaon mein prajanan kriya par nakaaraatmak prabhaav padta hai. iske parinaamasvaroop prajanan dushkriya hoti hai, jaise ki dinbaksharan, dinbagranthi pind mein kami, maasik chakr ki samasyaaen ya aniyamitata aur samay se pehle rajonivrutti.[20] dusaadhya sharaabiyon aur madiraapaanotsav ka jinka haal ka itihaas hai, ko ketoesidosis ho sakta hai.[46]

manorog ke lakshan

lambe samay se sharaab ke anuchit sevan se maanasik svaasthya ki anek samasyaaen paida ho sakti hain. gambhir sanjnyaaanaatmak samasyaaen asaamaanya naheen hain; manobhransh athva paagalapan ke lagbhag 10 pratishat maamale sharaab ke upabhog se jude hain, jisse manobhransh ke pramukh kaaranon mein sharaab doosare sthaan par aa pahuncha hai.[47] atyadhik sharaab peene se mastishk ki kaarya pranaali ko nuksaan pahunchata hai aur samay ke saath teji se maanasik svaasthya prabhaavit ho sakta hai.[48] sharaabiyon mein manorog sambandhi vikaar aam hain, lagbhag 25 pratishat sharaabi gambhir manorog sambandhi gadbadi se peedit hain. sabse adhik prachalit manorog ke lakshan chinta aur avasaad vikaar hain. sharaab chhod dene par aamtaur par shuroo mein manorog ke lakshan kaheen adhik kharaab dikhne lagte hain, lekin sanyam ki nirantarata se aam taur par ismein sudhaar aata hai ya ye sire se gaayab ho jaate hain.[49] sharaab ke apaprayog se manovikruti, bhram aur chetan mastishk sanlakshan ho sakte hain, jo sijofreniya jaise rog ke hone ke galat lakshan dikhla sakte hain.[50] lambi avadhi ke sharaab ke apaprayog ke seedhe parinaamasvaroopaaatank vikaar viksit ho sakta hai ya badatar roop dhaaran kar sakta hai.[51][52]

bade avasaadagrastata vikaar aur madyavyasanita ya piykkadpan sahavarti ghatna ke roop mein bakhoobi darj hain.[53][54][55] jinmein komorabid (atirikt rugnata ya ek se adhik rugnata ka sah-astitv) ki upasthiti hua karti hai, unke liye aam taur par ek antar kiya jaata hai- aise avasaadi prasang jo sharaab ke tyaag ke baad ghat jaaya karte hain ("padaarth-prerit") aur aise avasaadi prasang jo ki pradhaan hain aur jo sharaab tyaagane se ghatate naheen ("svatantr" prasang). [56][57][58] anya davaaon ka atirikt upayog sharaabiyon mein avasaad ke khatre ko badha sakta hai.[73]

manorog vikaar ling ke aadhaar par bhinn hote hain. jin mahilaaon mein sharaab peene ke kaaran vikaar paida hue hain, unamein bade avasaad, chinta, aatank vikaar, atikshudha, abhighaatajottar tanaav vikaar (PTSD), ya baurdaralaain vyaktitv vikaar jaise sah-ghatit manorog nidaan aksar hote hain. jin purushon mein sharaab peene ke kaaran vikaar paida hue hain, unamein aatmakaami ya samaaj-virodhi vyaktitv vikaar, dvidhruveeya vikaar, sijofreniya, aavegi vikaar, ya dhyaan mein kami/atiskriyta vikaar ke sah-ghatit nidaan paae jaate hain.[59] bahut sambhav hai ki aam mahila aabaadi ki tulana mein madyavyasanita ki shikaar mahilaaon ke saath shaareerik ya yaun utpeedn, bura bartaav aur ghareloo hinsa ki ghatnaaen adhik ghati hongi,[59] jisse manorog vikaar ke uchch drushtaant dekhe ja sakte hain aur sharaab par adhik nirbharata paida ho sakti hai.

inhein bhi dekhein: saamaajik prabhaav

madyavyasanita ya piykkadpan se paida hone waali samasyaaen gambhir hain, jo alkohal arthaat sharaab se mastishk mein manovikaari parivartan aane aur sharaab ke maadak prabhaav ke kaaran hota hai.[47][60] sharaab ke apaprayog se baal-utpeedan, ghareloo hinsa, balaatkaar, chori aur maarapeet sahit aaparaadhik ghatnaaon mein vruddhi ho rahi hai.[61] piykkadpan ke saath rojagaar ki kshati judi hui hai,[62] jisse aarthik nuksaan hota hai. galat samay mein sharaab peene aur nirnaya karne mein chook se hue galat vyavahaar se kaanooni nateeje bhogane pad sakte hain, jaise ki nashe mein gaadi chalaane[13] ya saarvajanik avyavastha failaane ke aaparaadhik aarop, ya kshatikr krutya ke liye deevaani aarthik dand aur aaparaadhik saja bhi ho sakti hai. nashe ke samay kisi sharaabi ka vyavahaar aur maanasik durbalata uske aaspaas ke logon par gaharaai se prabhaav daal sakta hai aur use parivaar tatha doston se alag-thalag kar sakta hai. is alagaav se vaivaahik vivaad aur talaak tak ki naubat aa sakti hai, ya ghareloo hinsa mein ijaafa ho sakta hai. sharaabeepan se bachchon ki upeksha bhi ho sakti hai, isse sharaabi ke bachchon ke bhaavanaatmak vikaas ko sthaayi kshati pahunch sakti hai.[12]

agar use theek se prabandhit na kiya gaya to barbeetyurets aur beinjodaayajepaains jaise ek samaan padaarth ke saath kisi shaamak-nidraakaari prakriya dvaara sharaab par nirbharata ke pratyaahaar ki koshish khatarnaak bhi ho sakti hai.[60][63] sharaab ka praathamik prabhaav hota hai gaabaA (GABAA) graahi (riseptar) ko uttejit karna, jisse keindreeya tantrika tantr ke avasaad ko badhaava milta hai. sharaab ke lagaataar aur bhaari upabhog se, ye abhigraahak ya riseptars asanvedi ho jaate hain aur inki sankhya kam ho jaati hai, jiska asar sahanasheelata tatha shaareerik nirbharata par padta hai. jab sharaab ke upabhog ko achaanak band kar diya jaata hai, tab sambandhit vyakti ka tantrika tantr aniyantrit chetopaagam firing (synapse firing) se peedit ho uthata hai. isse vyagrata, aatmahatya ka daura, kanponmaad, matibhram, tharatharaahat aur sambhaavit hradaya gati ke rukane jaise lakshan dikh sakte hain.[64][65] anya nyoorotraansameetar tantr bhi shaamil hai, vishesh roop se dopemaain aur enaemadeee.[10][66]

sharaab chhodne ke teevr lakshan ek se teen saptaah ke baad kam hone lagte hain. kam gambhir lakshan (jaise ki anidra aur vyagrata, aanandamayi anubhooti ka poorn lop) sharaab pratyaahaar ke baad ke sanlakshan ke hisse ke roop mein jaari rah sakte hain, jinmein dheere-dheere sanyam ke saath ek saal ya usase bhi adhik samay mein sudhaar ho sakta hai.[67][68][69] pratyaahaar lakshan kam hone shuroo hote hain jab shareer aur keindreeya tantrika tantr sharaab sahanasheelata aur gaaba kriya ko saamaanya banaane lagte hain.[70][71]

kaaran

madyavyasanita ke vikaas ke jokhim ko aanuvaanshik aur paryaavaraneeya kaarakon ka ek jatil mishran prabhaavit karta hai.[72] jeen jo sharaab ki ras-prakriya ko prabhaavit karta hai, vahi madyavyasanita ke jokhim ko bhi prabhaavit karta hai aur madyavyasanita ke paarivaarik itihaas ko jaahir karta ho sakta hai.[73] ek shodh patra ne paaya ki kam umr mein sharaab ka sevan jeen ke prakatan ko prabhaavit kar sakta hai, jo sharaab par nirbharata ke jokhim mein vruddhi karta hai.[74] jin vyaktiyon mein sharaab ke liye aanuvanshik jhukaav hai, ve bhi bahut sambhav ausat roop se kam umr mein hi peena shuroo kar sakte hain.[75] iske alaava, kam umr mein sharaab peene ki shuruaat ke saath madyavyasanita ya piykkadpan ke vikaas ka jokhim juda hua hai,[75] aur kareeb 40 feesadi sharaabi apne kishoraavastha ke ant tak bahut jyaada peene lagte hain. yeh poori tarah spasht naheen hai ki yeh judaav kaaranaatmak hai ya naheen aur kuchh shodhakarta is vichaar se sahamat naheen hain.[76] drag nirbharata ke jokhim mein aam vruddhi bhi bachapan ke gambhir maanasik aaghaat se judi hai.[72] mitr mandali aur parivaar ke sahayog ka abhaav madyavyasanita ke vikaas ke saath juda hua hai.[72] sharaab ke puraane apaprayog ke nyoorotauksik prabhaav ki badhi hui sanvedanasheelata ke saath aanuvanshiki aur kishoraavastha judi hui hain. nyoorotauksik prabhaav ke kaaran valkuteeya vikruti (Cortical degeneration) aavegi vyavahaar ko badha deta hai, jo sharaab upabhog ke vikaar ke vikaas, saatatya aur ugrata mein yogadaan kar sakta hai. is baat ke pramaan hain ki sanyam se sharaab janit keindreeya tantrika tantr ki kshati ko thoda-bahut durust kiya ja sakta hai.[77]

aanuvanshik vibhinnata

vibhinn jaateeya samoohon mein aanuvanshik vibhinnata maujood hain, jo sharaab nirbharata ke jokhim ko prabhaavit karti hain. udaaharan ke liye, chayaapachayi kaise karte hain, is par afreeki, poorvi Asiaee aur indo-nasli samoohon mein antar hai. maana jaata hai ki aanshik roop se ye aanuvaanshik kaarak nasleeya samoohon mein sharaab nirbharata ki dar mein antar ki vyaakhya karte hain.[78][79] alakohal dihaaidrojanej yugmaviklpi (aleli) edeeecha1 bi*3 (ADH1 B*3) ke kaaran sharaab ke chayaapachaya ki kriya aur bhi adhik teji se hoti hai. yugmaviklpi edeeecha1 bi*3 (ADH1 B*3) keval unheen mein paaya jaata hai jo afreeki vanshaj hain aur ameriki ke kuchh mool nivaasi janajaatiyon ke hain. yeh yugmaviklpi jin afreeki aur deshi amerikiyon mein hota hai unamein madyavyasanita viksit hone ka khatra kam hota hai.[80] baharahaal, deshi amerikiyon mein ullekhaneeya roop se ausat ki tulana mein madyavyasanita ki dar bahut adhik hoti hai; yeh saaf naheen hai ki aisa kyon hota hai.[81] anya jokhim kaarak jaise ki saanskrutik maahaul ka prabhaav, udaaharan ke liye gori nasl mein ki tulana mein deshi amerikiyon madyavyasanita ke star ki uchch dar ki vyaakhya karne par sadama lag jaata hai.[82][83]

daihik-vyaadhi vigyaan (paithofijiyolauji)

sharaab ka praathamik prabhaav keindreeya tantrika tantr ke avasaad ko badhaava dene ke saath GABAA abhigraahak ki uttejana mein vruddhi karna hai. baar-baar bhaari maatra mein sharaab ke sevan ke saath, ye abhigraahak asanvedi ho jaate hain aur iski sankhya ghat jaati hai, iska asar sahishnuta aur shaareerik nirbharata par padta hai.[64] sharaab ki maatra jise jaivik roop se sansaadhit kiya ja sakta hai aur iska prabhaav lingon mein alag-alag hota hai. purushon aur mahilaaon dvaara baraabar khuraak mein sharaab ka sevan kiye jaane par aamtaur par dekha gaya hai ki mahilaaon ke rakt mein sharaab ki saandrata (BACs) uchch hoti hai.[59] iske liye kai kaaranon ko jimmedaar thaharaaya ja sakta hai, jismein se mukhya kaaran yeh hai ki mahilaaon ke shareer mein purushon ki tulana mein kam paani hota hai. at: sharaab ki ek nishchit raashi ek aurat ke shareer mein adhik keindrit ho jaata hai. sharaab ki di gayi maatra mahilaaon mein bahut adhik nasha karta hai, iski vajah yeh hai ki purushon ki tulana mein mahilaaon ke haarmon ka srov bhinn hota hai.[21]

nidaan

inhein bhi dekhein: vyasan aushadhi

saamaajik baadhaaen

sharaab durupayog ke upachaar aur jaanch mein pravrutti aur saamaajik chhavi adchan ban sakte hain. yeh purushon ki tulana mein mahilaaon ke liye kaheen adhik baadhak hai. badnaam ho jaane ke dar se mahilaaen apne peene ki baat ko chhipaane ke liye is baat se inkaar karti hai ki ve kisi chikitseeya sthiti se peedit hain. parinaamasvaroop yeh ravaiya parivaar, chikitsakon aur anya ke liye shak karne ki gunjaaish ko kam kar deta hai ki jis mahila ko ve jaante hain vah ek madyap hai.[20] iske vipreet, kisi chiktsikeeya sthiti se peedit hain yeh sveekaar karne mein purushon ko badanaami ka dar kam hota hai, iseeliye ve khuleaam saarvajanik taur par peene ka pradarshan karte hain aur samooh mein peete hain. parinaamasvaroop unke is ravaiye se parivaar, chikitsak aur anya achhi tarah jaante hain ki jis aadmi ko ve jaante hain vah ek sharaabi hai.[59]

jaanch

sharaab ke sevan ke niyantran ki haani ka pata lagaane ke liye kai upakaranon ka istemaal kiya ja sakta hai. ye upakaran jyaadaatar prashnaavali ke roop mein aatm-prativedan hote hain. ek anya aam vishay ek score ya taili hai jo sharaab ke sevan ki saamanya gambheerta ka sankshipt vivran prastut karta hai.[15]

jise CAGE (seeejeei) prashnaavali naam diya gaya hai usamein chaar prashn hote hain, inmein se harek aisa udaaharan hota hai jo chikitsak ke kaaryaalaya mein mareej ki turant jaanch kar leta hai. sharaab se sambandhit samasyaaon ka pata lagaane mein CAGE (seeejeei) prashnaavali bahut adhik prabhaavakaari hota hai; haalaanki jin logon mein sharaab se sambandhit samasyaaen apekshaakrut kam gambhir hain, jaise gori mahilaaon aur college ke chhaatron mein, yeh seemit roop se kaam karta hai.[84]

sharaab nirbharata ka pata lagaane ke liye anya kism ke jaanch ka bhi istemaal kiya jaata hai, masalan; sharaab deta nirbhar prashnaavali (alakohal dipeindeins data kveschaner), jo ki CAGE (seeejeei) prashnaavali ki tulana mein bahut hi adhik samvedansheel naidaanik jaanch hai. atyadhik maatra mein sharaab ke sevan aur sharaab nirbharata ke beech ke antar ko spasht karne mein yeh madad karta hai.[85] Michigan alakohal screening test (MAST (emaeesati)), ek jaanch upakaran hai madyavyasanita ke liye vyaapak roop se adaalat dvaara sharaab se sambandhit aparaadh[86] ke liye uchit saja dene ke liye iska istemaal kiya jaata hai aise aparaadh mein sharaab ke nashe mein gaadi chalaana sabse aam hai. sharaab ke prayog se honevaale vikaar ki pehchaan jaanch (alakohal yooj diordars aaideintifikeshan test) (AUDIT eyoodeeaaiti)) vishv svaasthya sangathan dvaara viksit ki gayi prashnaavali hai, is anokhe jaanch ko chhah deshon mein vaidhatata praapt hai aur antarraashtreeya star par iska prayog kiya jaata hai. CAGE (seeejeei) prashnaavali ki tarah, gambhir jaanch ke maamale mein achhe nateeje praapt karne liye is prashnaavali ka upayog kiya jaata hai.[87] jo durghatana ko anjaam dete hain ya aapaatkaaleen vibhaag mein jaate hain, unke saath sharaab sambandhit samasyaaon ki jaanch ke liye paidingaton alkohal test (PAT peeeti) ko design kiya gaya hai. yeh AUDIT prashnaavali ke saath achhi tarah se mel khaate hai, lekin paanch baar iski madad li jaati hai.[88]

aanuvanshik pravrutti ka pareekshan

manochikitsak anuvaanshikvid John I. nanbargar aur laura jeen biroot ka kehna hai ki madyapaan ka koi ek kaaran naheen hota, balki —aanuvaanshik sameta— "jo shareer aur dimaag ki prakriyaaon ko prabhaavit karte hue suraksha ya atisanvedanasheelata ki bhaavana ke nirmaan ke liye paraspar ek-doosare ke saath aur jeevan ke vyaktigat anubhavon ko prabhaavit karne mein jeen ek mahatvapoorn bhoomika ada karta hai". ve yeh bhi kehte hai ki kuchh logon ki tulana mein madyavyasanita se sambandhit ek darjan jeen ki pehchaan ho chuki hai, lekin aur bhi kuchh ki khoj kiya jaana abhi baaki hai.[89]

yug‍aamavikl‍aapi (aleel) ke liye kam se kam ek aanuvanshik pareekshan hai jo madyapatata aur afeemayukt maadak dravya se sambandhit hai.[90] maanav dopaameen abhigraahak jeeno ka pata lagaane yogya bhinnata hoti hai jise deeaaradee2 taik-I (DRD2 TaqI) bahuroopata kaha jaata hai. un logon mein jinmein yeh bahuroopata wala A1 aleel (bhed) to kam hota hain, lekin unamein endorfin nishkaasit karne wala afeemayukt maadak padaarth aur sharaab ki lat ki pravrutti bahut adhik hai.[91] haalaanki sharaabiyon aur afeemayukt maadak padaarthon ka sevan karanevaalon mein yeh aleel thoda adhik aam hai ye apne aap mein madyavyasanita ka samuchit andaaj lagaanevaale naheen hote aur kuchh shodhakartaaon ka maanana hai ki DRD2 ka pramaan virodhaabhaasi hai.[89]

deeesaem (DSM) dvaara beemaari ki pehchaan

sharaab par nirbharata ka deeesaem-IV (DSM-IV) nidaan paddhati madyapaan ki paribhaasha ka pratinidhitv karta hai. ek tarah se yeh anusandhaan protokaul ke vikaas mein madad karne ke liye hai, jiske nateejon ki tulana anya se ki ja sakti hai. deeesaem-IV (DSM-IV) ke anusaar, sharaab par nirbharata ki ek pehchaan nimn hai:[14]

...

mailaadaiptiv alkohal yooj vith kleenikli signifeekant impeyarmeint aij maineefested baai ait leest three of the folauing videen eni van-iyar peeriyd: tolereins; vithdraul; teken in greater amaaunts or ovar laungar time course dain inteinded; dijaayar or ansaksesaful atempts too kat daaun or control yooj; great deal of time speint aubtening, yoojing, or rikvaring fraum yooj; soshiyl, aukyoopeshanal, or reekriyeshnal ektivitij given ap or reedyusad; kanteenyood yooj despaait naulej of fijikl or saaikolaujikl sequel.

mootr aur rakt pareekshan

sharaab ke vaastavik upayog ke liye vishvasaneeya pareekshan hai, jismein ek saamaanya pareekshan rakt mein sharaab avayav ka pareekshan (beeesi (BAC)) hai.[92] ye pareekshan madyavyasani se gair madyavyasani ke antar ko spasht naheen karta hai; haalaanki lambe samay tak ati maatra mein madyapaan ka shareer par pahachaanane yogya prabhaav hota hai. ismein nimn shaamil hai:[93]

  • maikrositosis (badha hua (emaseevi (MCV))
  • unnat (jeejeeti (GGT))
  • eesati (AST) aur eelati (ALT) aur eesati (AST) ki sanyat unnati: eelati (ALT) ka anupaat 2:1 hai.
  • uchch kaarbohaaidret ki kami (seedeeti (CDT)) traansaferin

haalaanki, jaivik chihnakon inmein se koi bhi rakt pareekshan utana hi sanvaadanasheel naheen hota jitna ki jaanch prashnaavali.

rokathaam

vishv svaasthya sangathan Europeeya sangh aur anya kshetreeya nikaayon, raashtreeya sarkaaron aur sansadon ne sharaab neetiyon ka gathan kiya hai taaki sharaab ke nuksaan ko kam kiya ja sake. [94][95] kishoron aur yuva vayaskon ko lakshya banaakar sharaab durupayog ke nuksaan ko kam karne ke liye mahatvapoorn kadam uthaaya gaya hai. sharaab par nirbharata aur iske durupayog se honevaale nuksaan ko kam karne ke liye badhti umr mein jab durupayog ki jaanevaale jaayaj aushadhiyaan jaise ki sharaab khareedi ja sakti hai, ko pratibandhit karne ya sharaab ke vigyaapan par pratibandh lagaane ka sujhaav atirikt tareeke ke roop mein diya gaya hai. jan maadhyam mein sharaab durupayog ke parinaamon ke baare mein vishvasaneeya, pramaanikta par aadhaarit shikshan abhiyaan ki sifaarish ki gayi hai. sharaab ke durupayog ki rokathaam ke liye aur yuvaaon mein maanasik sehat sambandhi samasyaaon mein madad ke liye maata pita ke liye dishaanirdesh diye jaane ki bhi sifaarish ki gayi hai. [96]

upachaar

upachaar vibhinn tarah ke hain, kyonki sharaab ko lekar alag-alag kai drushtikon hain. jo madyavyasanita ko kisi ki saamaajik vikalp ke roop mein dekhte hain unki tulana mein jo ise chikitsakeeya sthiti ya beemaari ke roop mein dekhte hain ve upachaar ka sujhaav dete hain. adhikaansh ilaaj logon ko apne sharaab ke sevan ko band karne mein madad karne par kendrit hain, jiske baad unhein sharaab ke prayog par pun: lautane se rokane mein unki madad karne ke liye jeevan prashikshan aur/ya saamaajik samarthan pradaan ki jaati hai. choonki madyavyasanita ke saath bahut saare kaarak hote hain, jo kis‍ai shakhs ko peena jaari rakhane ke liye protsaahit karta hain, un sabko safalataapoorvak poorvaavastha mein praapt hone ke roop mein dekha jaana chaahiye. vishharan ke baad aatm-sahaayata samooh mein sahaayak upachaar ke sanyojan mein upasthit hona aur tantr ka mukaabala ke liye lagaataar honevaala vikaas is tarah upachaar ki ek misaal hai. madyavyasanita ka upachaar karanevaale samudaaya aamtaur par shoonya sahishnuta aadhaarit paddhati ka samarthan karte hain, haalaanki iseeke saath kuchh aise bhi hain jo nuksaan ko kam karanevaale paddhati ko protsaahit karte hain.[97]

sharaabiyon ke liye kisi paripoorak maadak padaarth, jaise beinjodaayajepaain, jiska ki sharaab ki tal chhudaane mein ek saaman prabhaav hai ka sanyojan kar sharaab vishharan (detoxification) ya sankshep mein 'ditauks' (detox) karne se apratyaashit roop se sharaab peena band ho jaata hai. jin vyaktiyon mein keval bahut hi maamooli pratyaahaar lakshanon ka halka sa khatra hai, unka vishharan baahari-mareejon ke roop mein kiya ja sakta hai. jo vyaktiyon ko gambhir pratyaahaar sanlakshan (sindrom) ka khatra hone ke saath-saath jo mahatvapoorn ya teevr ati-asvasth sthiti ke shikaar hote hain, unka ilaaj aam taur par aspataal mein rahakar ilaaj karaane vaale mareejon ke roop mein kiya jaata hai. vishharan madyavyasanita ka vaastavik ilaaj naheen karta hai aur sharaab par nirbharata ya apaprayog mein poorvaavastha ki praapti ke khatre ko kam karne ke liye vishharan ke baad upayukt upachaar kaaryakram jaroori hai.[16]

samooh therepi aur manochikitsa

benaami sharaabi ka ek kshetreeya seva kendra.

antarnihit manovaigyaanik muddon, jinse sharaab ki lat sambandhit hai ke saath vibhinn tarah ke samooh upachaar aur manochikitsa ka istemaal kiya ja sakta hai, iseeke saath hi saath poorvaavastha praapti ki rokathaam ka kaushal bhi pradaan kiya ja sakta hai. sharaabiyon ko parahej banaaye rakhane mein madad ke liye paraspar-sahaayata vaale samooh-paraamarsh ka paddhati sabse jyaada aam hai.[17][18] paraspar, gair peshevar paraamarsh pradaan karne ke liye anya sangathanon mein se alkohalik enonims naam ka ek pehla sangathan hai aur ab bhi yeh sabse bada sangathan hai. anya mein laaifaring secular rikvari (LifeRing Secular Recovery), SMART rikvari (smart rikvari) aur vumen for sabraaiiti (Women For Sobriety) shaamil hain.

khuraak aur sanyam

khuraak aur sanyam kaaryakram jaise ki maudareshan management (Moderation Management) aur drinkavaaij (DrinkWise) poori tarah se parahej ka samarthan naheen karta hai. jabki adhikaansh sharaabi is tarah se apne peene ki seema tay karne mein asamarth hote hain, kuchh sanyam ke saath peena fir se shuroo kar dete hain. 2002 mein national Institute on alakohal ebyooj end alkohalijm (enaaaieee) dvaara kiya gaya ameriki adhyayan bataata hai ki ek saal se adhik pehle kam-jokhim sharaab sevan ki shreni mein pahuainchaane vaalon ke 17.7 pratishat vyaktiyon ka nidaan sharaab nirbhar ke roop kiya gaya. haalaanki, is samooh mein nirbharata ke bas kuchh hi praarambhik lakshan dekhe gaye.[98] ek hi vishay ka upayog karte hue ek anuvarti adhyayan mein varsh 2001-2002 mein peene mein hue sudhaar ke maamale ko 2004-2005 mein samasyaajanit peene ki or fir se laut jaane ki dar se jaancha gaya. adhyayan mein paaya gaya ki sharaab se parahej sharaab se kaaboo paane ka sabse sabse adhik drudh tareeka hain.[99] deerghakaalik (60 saal) tak sharaabi purushon ke do samoohon ka anuvartan kiye jaane par paaya gaya ki "dashakon tak fir se peena shuroo kiye bagair ya parahej ko barkaraar karne ki apeksha niyantrit hokar fir se peena shuroo karne mein drudhta bamushkil se bani rahati hai. "[100]

aushadhiyaan

madyavyasanita ke ilaaj ke ansh ke roop mein vibhinn tarah ki aushadhiyaan di ja sakti hai.

vartamaan samay mein chikitsa mein upayogi

  • entaabyooj (Antabuse) (disulafirm) eseetaildihaaid, jo ithenaul ke raasaayanik parivartan ke dauraan shareer dvaara utpann hone wala ek rasaayan hai, ke nishkaasan ko rokata hai. eseetaildihaaid apne aapamein hi sharaab ke sevan honevaale bahut tarah ki khumaari ke lakshanon ka kaaran hai. atyadhik teevr gati se kriya karne wala aur lambe samay tak bane rahane wala takaleefadeya khumaari pradaan karanevaala sharaab jab piya jaata hai to kul milaakar iska prabhaav atyant kashtadaayak hota hai. jab ve yeh dava le rahe hote hain to yahi baat sharaabi ko atyadhik maatra mein peene se hatotsaahit karti hai. 9 saal se kiye ja rahe adhyayan se haal hi mein pata chala ki vyaapak upachaar kaaryakram mein paryavekshit disulafirm aur sambandhit yaugik kaarbaamaaid ke sanyojan ka nateeje mein parahej karne ki dar 50 pratishat se adhik thi.[101]
  • jis tarah se entaabyooj kaam karta hai, usi tarah temaposil (Temposil) (kailshiym kaarbeemaaid) (calcium carbimide) bhi kaam karta hai; ismein laabh yeh hota hai ki kabhi kabhi disulafirm (disulfiram), hepatotauksiti (hepatotoxicity) aur uneendepan ka ek pratikool prabhaav kailsiym kaarbeemaaid ke saath naheen hota hai.[101][102]
  • nelatreksaun (Naltrexone) opioid (opioid) abhigraahak ke liye pratispardhaatmak pratipkshi hota hai, yeh endorfin (endorphins) aur afees ke prabhaav ko prabhaavi roop se rok deta hai.

nelatreksaun ka upayog sharaab ke liye talab ko kam karne aur isse parahej ke liye protsaahit karne ke liye kiya jaata hai. sharaab ke kaaran shareer se endorfin ka nishkaasan hota hai, iske badle dopaamaain (dopamine) ka nishkaasan hota hai aur iske pratifl sakriya ho jaata hai; isliye jab nelatreksaun shareer mein hota hai to sharaab ke sevan se honevaala aanandadaayak prabhaav kaafi kam ho jaata hai.[103] madyavyasanita ke ek aur upachaar vidhi mein nelatreksaun ka upayog hota hai, jo sinkleyar paddhati kahalaata hai, yeh mareej ka upachaar nelatreksaun aur lagaataar sevan ke sanyojan ke maadhyam se kiya jaata hai .[104]

  • kainparal (Campral) ekainprosait (acamprosate), yeh sharaab ki nirbharata ko nyoorotraansameetar glutaamet, uttar-nirliptata ke charan mein atyadhik sakriya hoti hai, ki pratikriyaasheelata ke jariye mastishk rasaayan ko sthir kar deta hai.

[105]

prayogaatmak aushadhiyaan

  • taupaamaiks (Topamax) taupiraamet (topiramate) praakrutik taur par paaye jaanevaale sharkar monosechcharaaid ka yaugik di-frutos, sharaabiyon ko sharaab chhudaane mein ya jitni maatra mein ve peete hain usamein kami karne mein yeh prabhaavi paaya gaya hai.

pramaan bataate hain ki taupiraamet uttejak glootaamet abhigraahakon ko virodhi bana deta hai, dopaameen ko mukt hone se rokata hai aur nirodhaatkam gaama-ameenobyootaayarik esid ki kriyaasheelata ko badhaata hai. 2008 mein taupiraamet ki prabhaavasheelata ki sameeksha ka nishkarsh nikaala ki prakaashit pareekshan ke parinaam aashaajanak hain, lekin 2008 mein jo bhi tha, vah pehli pankti ke sharaab nirbhar agent ke liye taupiraamet ke upayog ke samarthan mein mahaj ek saptaah ke anupaalan ke paraamarsh se jod kar dekha jaae to vah data aparyaapt tha.[106]‍ 2010 ki ek sameeksha se pata chala ki maujooda sharaab faamaakotherapyootik vikalp ke liye taupiraamet behtar ho sakta hai. taupiraamet prabhaavi roop se talab aur sharaab nirliptata ki gambheerta ko kam kar dene ke saath hi saath jeevan ki gunavatta ke moolyaankan mein bhi sudhaar laata hai.[107]

aushadhiyaan jinka parinaam bura ho sakta hai

  • beinjodaayajepaains, teevr sharaab nirliptata mein haalaanki yeh bahut hi upayogi dava hai, lekin agal lambe samay tak iska istemaal kiya jaata hai to madyavyasanita mein iska parinaam bura ho sakta hai. kronik madyavyasanita mein ke maamale mein beinjodaayajepaains mein sharaab se parahej ki dar, unke banispat jo beinjodaayajepaains naheen le rahe hain, se kam hai. is varg ki davaaen aamtaur par sharaabiyon ko anidra ya chinta ke saman ke liye di jaati hai.[108] svaasthya laabh ke silsile mein vyaktiyon ko beinjodaayajepaains ya shaamak-nidraajanit dava diye jaane se beemaari ke punaraavartan ki uchch dar pai gayi, ek lekhak ki report hai ki shaamak-nidraajanit dava ke nuskhe se ek chauthaai se adhik log fir se poorvaavastha mein ja pahunche. mareej aksar galati se soch lete hain ki beinjodaayajepaains lena jaari rakhane ke baavajood ve sanyami hain. jo beinjodaayajepaains ka sevan lambe samay se kar rahe hain unhein yakabayak lena band naheen kar dena chaahiye, isse ho sakta hai gambhir chinta aur aatank viksit ho jaae, jo ki pratyaava‍aavartit hokar sharaab ke apaprayog ka jaanaamaana jokhim kaarakon ban jaata hai. nirliptata mein kam teevrata ke saath 6-12 maheene ke tepar paddhati ko bahut hi safal paaya gaya hai.[109][110]

dohari lat

sharaabiyon ko anya saaikotraupik maadak padaarthon ke lat se upachaar ki bhi aavashyakta hoti hai. madyata ke maamale mein sharaab nirbharata ki sabse aam dohari lat hai beinjodaayajepaain par nirbharata hai, adhyayan bataata hai ki 10-20 pratishat sharaab nirbhar vyakti mein nirbharata aur/ya duruprayog ki samasya beinjodaayaje‍aapaain ke hi kaaran hain. samasyaagrast sharaabi dvaara jitni maatra mein sharaab ka sevan karte hain, beinjodaayajepaain sharaab ke liye laalasa mein vruddhi karti hai.[111] beinjodaayajepaains nirbharata ko kam karne ke liye parinaamon se bachane ke beinjodaayajepaain nirliptata sindrom aur anya svaasthya sambandhi khataron se bachane ke liye saavadhaani se khuraak dene ki aavashyakta hoti hai.

anya shaamak nidraajanak davaaen jaise ki jolapidem aur jopiklon ke saath hi saath afeemayukt aur avaidh maadak dravyon par nirbharata sharaabiyon mein aam hai. sharaab apne aapamein ek shaamak-nidraajanak dravya hai aur yeh anya shaamak-nidraajanak padaarthon jaise ki baarbiturets, beinjodaayajepaains aur naun-beinjodaayajepaains ke saath sahanasheel-virodhi hota hai. shaamak-nidraajanak se nirmarata aur nirliptata chikitsa ki drushti se gambhir ho sakta hai aur agar sanbhaal kar iska upaaya naheen kiya gaya to sharaab ki nirliptata se manovikruti aur daura padne ka khatra hota hai.[19]

mahaamaari vigyaan

2002 ke jeevan mein 100.000 nivaasi sharaab ke prati ka upayog viklaangata se samaayojit hai.[258][259][260][261][262][263][264][265][266][267][268][269][270]
prati vaarshik sharaab record (15+) prati liter vyakti ka upabhog[112]

is cheej ke sevan se paida honevaale vikaar se bahut saare deshon ko ek pramukh saarvajanik svaasthya samasya ka saamana karna padta hai. "sharaab ke ilaaj ke liye aae mareejon mein sabse aam tatv iska apaprayog/nirbharata hai."[97] 2001 mein United kingadam mein, 'nirbharasheel madyapon' ki sankhya 2.8 lakh se adhik bataayi gayi thi.[113] America ke vayaskon mein lagbhag 12% ke jeevan mein kabhi na kabhi sharaab nirbharata se samasya rahi hai.[114] vishv svaasthya sangathan ka anumaan hai ki duniya bhar mein lagbhag 140 million log sharaab nirbharata se grast hain.[22][23] sanyukt raajya America aur pashchimi Europe ke 10 se 20 pratishat purush tatha 5 se 10 pratishat mahilaaen apne jeevan mein kisi mod par madyavyasanita ke maanadandon ko poora kareinge hi.[115]

chikitsa aur vaigyaanik samudaayon mein madyavyasanita ke baare mein ek aam sahamati hai ki yeh ek beemaari ki sthiti hai. udaaharan ke liye, American medical association alakohal ko ek drag maanata hai aur kehta hai ki "maadak padaarthon ki lat ek kronik, pratyaavarti dimaagi beemaari hai, jismein baadhyakaari roop se maadak padaarthon ki talab hoti hai aur iske vinaashakaari parinaam ke baavajood baarabaar iska prayog kiya jaata hai. yeh jaivik atisanvedanasheelata aur paryaavaran jokhim ke paraspar jatil prabhaav aur vikaas kaarakon (jaise ki mastishkeeya paripkvata ka star) ka parinaam hai."[41]

purushon mein madyavyasanita ka prachalan kaheen adhik hai, haalaanki haal ke dashakon mein mahila madyapon ke anupaat mein vruddhi hui hai.[212] vartamaan saakshya sanket dete hai ki 40-50 pratishat paryaavaraneeya prabhaav ko chhod diya jaae to purushon aur mahilaaon donon mein, madyavyasanita ka 50-60 pratishat aanuvanshik taur par nirdhaarit hota hai.[116] madyavyasanita ka vikaas jyaadaatar sharaabiyon mein kishoraavastha ya yuva vayaskata ki avastha ke dauraan hota hai.

poorvaanumaan

2002 mein national insteetyut on alakohal ebyooj end alkohalijm ne sharaab nirbharata ki kasauti ke liye 4,422 ke ek samooh ka sarvekshan kiya aur paaya ki ek saal ke baad, kuchh log sharaab sevan ke kam jokhim ki lekhak ki kasauti mein khare utare, jabki samooh ke sirf 25.5 feesadi ka hi koi ilaaj kiya gaya. iska byaura neeche pesh kiya ja raha hai: 25 feesadi ko abhi bhi sharaab nirbhar paaya gaya, 27.3 feesadi aanshik roop se durust hue (kuchh lakshan jaari rahe), 11.8 feesadi sparshonmukh (asymptomatic) piykkad rahe (upabhog badhne se poorvaavastha ki vaapasi ka khatra) aur 35.9 feesadi poori tarah se durust hue - inmein 17.7 feesadi kam-jokhim peene vaale aur 18.2 feesadi madya-tyaagi shaamil hain.[117]

tathaapi, iske vipreet, Harvard medical school ke George vaillaant dvaara do samoohon par lambe samay tak kiye gaye adhyayan se jaahir hua ki "poorvaavastha ki vaapasi ya sanyam ke vikaas ke bina niyantrit sharaab sevan mushkil se ek dashak se adhik tak tik paata hai."[118] vaillaant ne yeh bhi not kiya ki "jaisa ki alpakaalik adhyayanon se pata chalta hai ki niyantrit sharaab sevan mein vaapasi aksar ek mareechika hoti hai."

madyapon mein mrutyu ka sabse aam kaaran hai hrudayavaahini samasya.[119] puraane sharaabiyon mein aatmahatya ki uchch dar hai, yeh pravrutti un vyaktiyon mein badhti jaati hai hai jinka peena adhik dinon tak chalta jaata hai. maana jaata hai ki sharaab ke kaaran mastishkeeya rasaayan ki daihik kshati se aisa hota hai, saath hi saamajik alagaav ke kaaran bhi. kishor sharaabiyon mein bhi aatmahatya bahut hi aam hai, kishoron mein aatmahatya ka 25 feesadi sharaab ke apaprayog se juda hua hai.[120] lagbhag 18 pratishat sharaabi aatmahatya kiya karte hain,[43] aur shodh mein paaya gaya hai ki 50 pratishat se adhik aatmahatyaaen sharaab ya drag nirbharata se judi hui hain. kishoron mein yeh aankada kaheen adhik oopar hai, 70 pratishat aatmahatyaaon mein sharaab ya nasheeli davaaon ki bhoomika hua karti hai.[121]

itihaas

abhilikhit poore maanav itihaas mein sharaab ke upayog aur durupayog ka ek lamba itihaas hai. baaibil, misr aur bebeelon ke sroton mein sharaab ke apaprayog aur is par nirbharata ka itihaas darj hain. kuchh praacheen sanskrutiyon mein sharaab ki pooja ki jaati thi aur anya iske apaprayog ki ninda kiya karte the. hajaaron saal pehle bhi atyadhik maatra mein sharaab durupayog aur madyapatata ko samasyaaon ka kaaran maana jaata raha hain. baharahaal, us samay ise aabhyaasik madyavyasanita ke roop mein paribhaashit kiya gaya aur 1700 ke dashak tak iske pratikool parinaamon ko chikitsakeeya taur par achhi tarah se sthaapit naheen kiya gaya. 1647 mein ek greek bhikshu[who?] ne pehli baar pramaanit kiya ki sharaab ka kronik durupayog tantrika tantr aur shareer mein vishaaktata se juda hua hai, jo kaaran kai tarah ke chikitkeeya vikaar jaise ki daura padna, pakshaaghaat aur andaruni taur par rakt ksharan hota hai. 1920 mein sharaab ke apaprayog aur puraani madyavyasanita ke prabhaavon ko dekhte hue sharaab ki vifal rahi nishedhaagya ko suvichaarit roop se antat: America mein kuchh samay ke liye laagoo kiya gaya. 2005 mein yooesae (USA) ki arthavyavastha mein sharaab par nirbharata aur iske apaprayog ki anumaanit laagat prativrsh lagbhag 220 billion dollar hai jo ki Cancer aur motaape se kaheen adhik hai. [122]

samaaj aur sanskruti

William hogaarth jin len, 1751

lambe samay tak sharaab ke sevan se honevaali svaasthya samasyaaen aamtaur par samaaj ke liye haanikaarak maani jaati hain, udaaharan ke liye, kaam ka samay barbaad hone se paison ka nuksaan, davaaon ki laagat aur iske doosare kram se ilaaj ka kharch. sharaab ka sevan sir par aaghaat, vaahan durghatana, hinsa aur maarapeet ka pramukh kaarak hota hai. paison ke alaava, sharaabi aur uske parivaar tatha doston ko khaas tarah se saamaajik moolya chukaana padta hai. [60] udaaharan ke liye, garbhavati mahila dvaara sharaab ke sevan se bhroon sharaab sindrom ka shikaar ho sakta hai,[123] jo ek laailaaj aur haanikaarak sthiti hai.[124]

sharaab ke apaprayog se aarthik nuksaan ka aankada vishv svaasthya sangathan dvaara ekatr kiya gaya hai, jo kisi desh ke sakal ghareloo utpaad (GDP (GDP)) ka ek se lekar chhah pratishat tak hota hai.[125] Australia mein sabhi prakaar ke nasheele padaarthon ke apaprayog mein sharaab ki anumaanit adhikeelit saamaajik laagat 24 pratishat hai; isi tarah Canada mein hue adhyayan ke anusaar sharaab ke hisse mein 41 pratishat jaata hai.[126] 2001 mein kiye gaye ek adhyayan mein UK (UK) ke sabhi prakaar ke alakohal ke durupayog ki nirdhaarit laagat 18.5-20 billion £ paayi gayi.[113][127]

roodhivaadi sharaabi aksar lokapriya sanskruti aur kaalpanik kahaani-upanyaas mein mil jaate hain. pashchim ki lokapriya sanskruti mein 'shahar ka piykkad' ek khaas charitra hota hai. roodhivaadi piykkadpan ho sakta hai naslavaad ya ajnyaaatajan bheeti par aadhaarit ho sakta hai, jaisa ki aayarish ke chitran mein bade piykkad ke roop mein hota hai.[128] stivrs aur grele jaise samaajik manovaijnyaaanikon dvaara kiye gaye adhyayan mein America mein rahanevaale aayarish mein vyaapak star par badi maatra mein sharaab ke sevan ko pramaanit karne ki koshish ki gayi hai.[129]

inhein bhi dekhein

  • sharaabi fefadon ke rog
  • parivaar pranaali mein sharaab
  • sharaab se sambandhit yaataayaat durghatanaaen
  • ghaatumaan peene
  • sharaab ki khapat ke aadhaar par deshon ki soochi

sandarbh

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