Alcoholism is a chronic,
progressive and often-fatal disease. The condition involves a
preoccupation with alcohol and impaired control over alcohol
intake. You may continue to abuse alcohol despite serious
adverse health, personal, work-related and financial
consequences. Alcoholism involves physical dependence on the
drug alcohol, but genetic, psychological and social factors
contribute to an addiction.
You may have a problem with
alcohol but not all the characteristics of alcoholism. Instead
you may demonstrate "alcohol abuse." This means you engage in
excessive drinking that results in health or social problems,
but you aren't dependent on alcohol and haven't fully lost
control over the use of alcohol.
According to the National Council
on Alcoholism and Drug Dependence, about 14 million Americans
abuse alcohol. Each year more than 100,000 Americans die of
alcohol-related causes. Alcoholism is one of the most common
preventable causes of death among Americans.
Alcoholism and alcohol abuse
cause major social, economic and public health problems in the
United States. The annual cost of lost productivity and health
expenses related to alcoholism is more than $150 billion.
Most alcoholics deny that they
have a drinking problem. Other signs of alcoholism and alcohol
- Drinking alone or in secret
- Not remembering conversations
- Making a ritual of having
drinks before, with or after dinner and becoming annoyed when
this ritual is disturbed or questioned
- Losing interest in activities
and hobbies that used to bring pleasure
- Irritability as usual drinking
time nears, especially if alcohol isn't available
- Keeping alcohol in unlikely
places at home, at work or in the car
- Gulping drinks, ordering
doubles, becoming intoxicated intentionally to feel good or
drinking to feel "normal"
- Having legal problems or
problems with relationships, employment or finances
Alcohol addiction physical
dependence on alcohol occurs over time as drinking alcohol
alters the balance of some chemicals in your brain, causing a
strong desire for more alcohol. These chemicals include gamma-aminobutyric
acid (GABA), which inhibits impulsiveness; glutamate, which
excites the nervous system; norepinephrine, which is released in
response to stress; and dopamine, serotonin and opioid peptides,
which are responsible for pleasurable feelings. Excessive,
long-term drinking can deplete or increase the levels of some of
these chemicals, causing the body to crave alcohol to restore
good feelings or to avoid negative feelings.
To develop alcohol addiction,
other factors that lead to excessive drinking contribute to the
addiction process. These include:
Your genetic makeup doesn't cause alcoholism. But, if you have
an imbalance of brain chemicals, you may be more predisposed
state. High levels of
stress, anxiety or emotional pain can lead some people to
drink alcohol to block out the turmoil.
Having friends or a close partner who drinks regularly but who
may not abuse alcohol could lead to excessive drinking on your
part. It may be difficult for you to distance yourself from
these "enablers" or at least from their drinking habits.
- Social and
cultural factors. The
glamorous way that drinking alcohol is portrayed in
advertising and in the entertainment media sends many people
messages that it's OK to drink excessively.
Steady drinking over time can
produce a physical dependence on alcohol. However, drinking by
itself is just one of the risk factors that contribute to
alcoholism. Other risk factors include:
People who begin drinking at an early age in their teens or
earlier are at a higher risk of becoming an alcoholic.
Your genetic makeup may cause imbalances in one or more of
several brain chemicals and increase your risk of alcohol
Men are more likely to become alcoholics than are women, but
the incidence of alcoholism among women has increased in the
past 30 years.
history. The risk of
alcoholism is higher for people who had a parent or parents
who abused alcohol. This is true even if you're adopted and
your adoptive parents don't drink alcohol.
severely depressed or having anxiety places you at a greater
risk of abusing alcohol.
to Seek Medical Advice
Because denial is nearly always a
characteristic of alcoholism, it's unlikely that people who are
alcoholic or who abuse alcohol will seek medical treatment on
their own. Often it takes family members, friends or co-workers
to persuade someone to undergo screening for alcoholism or to
Screening and Diagnosis
It's often difficult for doctors
to screen for people who may have an alcohol problem and to
recognize symptoms of alcoholism. For example, symptoms such as
memory loss or falling might be the result of aging rather than
indications of alcohol abuse. Because alcoholism involves
denial, people may complain to doctors about digestive problems
or pain or weakness, but never reveal their abuse of alcohol.
A doctor who suspects an alcohol
problem may ask a number of questions regarding drinking habits
in order to get an indication of the level of drinking. If
answers to those questions indicate possible alcoholism or
alcohol abuse, the doctor may perform a short screening test
using a standardized questionnaire.
Blood alcohol tests aren't useful
in diagnosing alcoholism because the tests show consumption at a
particular point in time, not long-term use. Other blood tests
that measure the size of red blood cells, which increase with
long-term alcohol use, and a factor known as
carbohydrate-deficient transferrin may indicate heavy alcohol
If other tests indicate other
health problems that may be alcohol-related such as tests
showing liver damage or reduced testosterone levels in men
this may be evidence that persuades an alcoholic to seek
Alcohol depresses your central
nervous system by acting as a sedative. In some people, the
initial reaction may be stimulation, but as drinking continues,
sedating or calming effects occur. By depressing the control
centers of your brain, alcohol relaxes you and reduces your
inhibitions. The more you drink, the more you're sedated.
Initially, alcohol affects areas of thought, emotion and
judgment. In sufficient amounts, alcohol impairs speech and
muscle coordination and produces sleep. Taken in large enough
quantities, alcohol is a lethal poison it can cause
life-threatening coma by severely depressing the vital centers
of your brain.
Excessive use of alcohol can
produce several harmful effects on your brain and nervous system
and cause fatigue, short-term memory loss, and weakness and
paralysis of your eye muscles. It can also have these other
severe health effects:
heavily can cause you to develop hepatitis, an inflammation of
the liver. Symptoms may include loss of appetite, nausea,
vomiting, abdominal pain and tenderness, fever, yellowing of
the skin (jaundice) and sometimes mental confusion. Over years
of drinking, hepatitis may lead to cirrhosis, the irreversible
and progressive destruction of liver tissue. A healthy liver
processes nutrients into forms your body can use, manufactures
bile to help digest fats and regulates the amounts of sugar,
protein and fat that enter your bloodstream.
Alcohol can result in inflammation of the lining of the
stomach (gastritis), which can lead to tears in the upper part
of your stomach and lower part of your esophagus. Alcohol can
also interfere with the absorption of the B vitamins,
particularly folic acid and thiamin, and other nutrients.
Heavy drinking can also damage your pancreas (pancreatitis).
The pancreas has two functions: (1) it produces the hormones
insulin and glucagon, which help regulate your metabolism, and
(2) it produces pancreatic juices and enzymes that help digest
fats, proteins and carbohydrates.
Excessive drinking can lead to high blood pressure and damage
your heart muscle (cardiomyopathy). These conditions can put
you at increased risk of heart failure or stroke.
prevents the release of glucose from your liver and can
increase the risk of your blood sugar falling too low
(hypoglycemia). This is dangerous if you have diabetes and are
already taking insulin to lower your blood sugar level.
function and menstruation.
Alcohol abuse can cause erectile dysfunction in men. In women,
it can interrupt menstruation.
defects. If you drink
excessively during pregnancy, your child may be born with
fetal alcohol syndrome. This condition results in birth
defects including a small head, heart defects, a shortening of
the eyelids and various other abnormalities. As these children
grow older, they may have various developmental disabilities.
Excessive drinking can affect your nervous system, causing
numbness of your hands and feet, disordered thinking and
Other complications of alcoholism
and alcohol abuse may include:
- Domestic abuse and divorce
- Poor performance at work or
- Increased likelihood of motor
- Greater susceptibility to
accidental injuries from other causes
- Higher incidence of suicide
Most alcoholics and alcohol
abusers enter treatment reluctantly because they deny the
problem. They often must be pressured. Health or legal problems
may prompt treatment. Intervention helps an alcoholic recognize
and accept the need for treatment. If you're concerned about a
friend or family member, discuss intervention with a
A wide range of treatments is
available to help people with alcohol problems. Treatment is
tailored to the individual. It may involve an evaluation, a
brief intervention, an outpatient program or counseling, or a
residential inpatient stay.
The first step in treatment is to
determine whether you're alcohol dependent. If you haven't lost
control over your use of alcohol, your treatment may involve
reducing your drinking. If you have alcoholism, cutting back is
ineffective and inappropriate, and abstinence must be a part of
your treatment goal.
If you aren't dependent on
alcohol but are experiencing the adverse effects of drinking,
the goal of treatment is to reduce alcohol-related problems,
often by counseling or a brief intervention. A brief
intervention usually involves alcohol-abuse specialists who can
establish a specific treatment plan. Interventions may include
goal setting, behavioral modification techniques, use of
self-help manuals, counseling and follow-up care at a treatment
The most common residential
alcoholism treatment programs in the United States are based on
the Minnesota model. This approach includes abstinence,
individual and group therapy, participation in Alcoholics
Anonymous (AA), educational lectures, family involvement, work
assignments, activity therapy and the use of counselors many
of whom are recovering alcoholics and multiprofessional staff.
Here is what you might expect
from a typical residential treatment program based in part on
the Minnesota model:
Detoxification and withdrawal.
Treatment may begin with a program of detoxification, usually
taking about 4 to 7 days. You may need to take medications to
prevent delirium tremens or other withdrawal seizures.
assessment and treatment.
Common medical problems related to alcoholism are high blood
pressure, increased blood sugar, and liver and heart disease.
Psychological support and psychiatric treatment.
Group and individual counseling and therapy support recovery
from the psychological aspects of alcoholism. Sometimes,
emotional symptoms of the disease may mimic psychiatric
Detoxification and medical treatment are only the first steps
for most people in a residential treatment program.
on acceptance and abstinence.
Effective treatment is impossible
unless you accept that you're addicted and unable to control
alcohol-sensitizing drug called disulfiram (Antabuse) may be a
strong deterrent. Disulfiram won't cure alcoholism nor can it
remove the compulsion to drink. But if you drink alcohol, the
drug produces a severe physical reaction that includes
flushing, nausea, vomiting and headaches. Naltrexone, a drug
long known to block the narcotic high, also reduces recovering
alcoholics' urge to drink. Unlike disulfiram, naltrexone
doesn't cause a reaction within a few minutes of taking a
drink. Naltrexone can produce side effects, particularly liver
programs and AA help recovering alcoholics abstain from
alcohol, manage relapses and cope with lifestyle changes.
Knowing and recognizing a family
history of alcoholism for you or others is an important step
toward seeking treatment before alcohol use or alcohol abuse
progresses to alcoholism.
Early intervention is
particularly important for teenagers. Although it may take years
for many adults to develop alcohol dependence, teenagers can
become addicted much more quickly. Alcohol use among teens
increases dramatically during the high school years, and with
serious health effects for many teens. Each year in the United
States, thousands of teenagers die or are disabled in
alcohol-related automobile accidents. Alcohol also is often a
cause in other teenage deaths, including drownings, suicides and
For young people, the likelihood
of addiction depends on the influence of parents, peers and
other role models, susceptibility to advertising, how early in
life they begin to use alcohol, their psychological need for
alcohol and genetic factors that may predispose them to
These signs may indicate your
teenager has a problem with alcohol:
- Less or no interest in
activities and hobbies
- Anxiety, irritability
- Difficulties or changes in
relationships with friends; joining a new crowd
- Declining grades
To prevent teenage alcohol use:
- Set a good example regarding
- Communicate with your
- Discuss the legal and medical
consequences of drinking.
Many recovering alcoholics and
their family members find that participating in support groups
is an essential part of coping with the disease and staying
The Fellowship of Alcoholics
Anonymous (AA) was formed in 1935. As a self-help group of
recovering alcoholics, AA offers a sober peer group as an
effective model of how you can achieve total abstinence.
The AA program is built around 12
steps, which are straightforward suggestions for men and women
who choose to lead sober lives. Following the 12 steps aren't
required for membership but rather are guides for people who
choose to live their lives sober. As guides to recovery, the 12
steps help alcoholics accept their powerlessness over alcohol.
They stress the necessity for honesty about the past and
Recovery in AA is based on
accepting the unique experience of each alcoholic. Through
listening and sharing stories, alcoholics learn they aren't
alone. There are no fees for membership, only a willingness to
In the mid-1950s, family members
of recovering alcoholics formed a complementary self-help group
called Al-Anon. Al-Anon is designed for people who are affected
by someone else's alcoholism. In sharing their stories, they
gain a greater understanding of how the disease affects the
entire family, not just the alcoholic. Al-Anon also accepts the
12 steps of AA as the principles by which participants are to
conduct their lives. It also emphasizes how members need to
learn detachment and forgiveness if they too are to be free of
In many communities, Alateen
groups are also available to provide support for teenage
children of alcoholics.
Your doctor or counselor can
refer you to an AA group. These groups are also commonly listed
in the phone book, in the local newspaper and on the Web. (www.SoberCity.com)
Complementary and Alternative Medicine
In addition to residential
treatment, many other approaches to alcoholism may help,
Acupuncture, the insertion of hair-thin needles under your
skin, may relieve cravings for alcohol. It may reduce anxiety
and depression, which lead some people to drink alcohol, and
alleviate tremors and fatigue, both often associated with
Biofeedback is a method of relieving symptoms of stress by
relaxing your muscles. It involves monitoring one of your
physiologic systems heart, respiration, skin resistance or
temperature change so that you can become more aware of your
body's stress and thus control it. Once you learn biofeedback
techniques, you can do them on your own at home.
Motivational enhancement therapy.
In this treatment a therapist helps you to acknowledge that
you have a problem and may guide you through stages to help
you change your behavior.
behavior therapy. You
and your therapist identify distorted thoughts and beliefs
that arouse psychological stress. You learn ways you can view
and cope with traumatic events differently, and you learn
alternative beliefs about the events and the impacts they have
on your life. Special emphasis is placed on learning to
develop a sense of mastery and control of your thoughts and
therapy involves pairing the drinking of alcohol with a strong
aversive response such as nausea or vomiting induced by a
medication. After repeated pairing, the alcohol itself causes
the aversive response and that decreases the likelihood of
relapse. For obvious reasons, aversion therapy tends to be
unappealing, although it's often effective.
July 03, 2002