What Is It?
Alcoholism (alcohol dependence) is a long-lasting illness that is characterized by:
A craving for alcohol
A physical dependence on alcohol, which means a person develops physical symptoms when he or she stops drinking
A continued need for alcohol despite alcohol-related psychological, interpersonal and physical problems
There is no absolute number of drinks per day that indicates a person has alcoholism, although alcoholics do eventually develop tolerance the gradual need for greater and greater amounts of alcohol to feel the same alcohol effects. There is also no absolute rule that says how frequently a person must drink to be considered an alcoholic. What really defines the illness of alcoholism is dependence the fact that the patient has come rely on alcohol psychologically and emotionally in his or her everyday life. Also, the person's body has come to depend on the presence of alcohol when it performs its normal functions, including chemical reactions in the brain. This means that when alcohol use suddenly stops, the body's accustomed internal environment changes drastically, causing symptoms of withdrawal such as tremors, rapid pulse, rapid breathing, fever, insomnia, hallucinations and seizures.
Alcoholism can be linked to a long list of psychological, interpersonal, social, economic and medical problems. Alcoholism can increase the risk of depression and suicide and play a role in violent crimes, including homicide and crimes of domestic violence (abuse of a spouse or child). It can lead to traffic accidents and even accidents involving intoxicated pedestrians who decide to walk home after drinking. Alcoholism also can lead to unsafe sexual behavior, resulting in accidental pregnancy or sexually transmitted diseases, including HIV/AIDS.
Alcohol dependence increases the risk of liver disease (hepatitis and cirrhosis), dangerously irregular heart rhythms ("holiday heart" syndrome), stomach ulcers, brain damage, stroke and other health problems. In pregnant women who drink alcohol, there is also the danger that the child will develop fetal alcohol syndrome, a cluster of health problems including unusually low birth weight, facial abnormalities, heart defects and learning difficulties.
In most Western countries, including the United States, the lifetime chance of developing alcoholism is about 10% for men and 3% to 5% for women. Although there is strong evidence that at least part of a person's risk for alcoholism is inherited, having a family history of alcoholism does not guarantee that someone will become an alcoholic. Other lifestyle factors a social setting where alcohol is a regular part, easy availability of alcohol, severe personal problems may be even more important than heredity in determining whether some people develop alcoholism. For those who have a strong family history of alcoholism, a supportive family and healthy friendships often can prevent the illness from starting.
To help determine whether someone has an alcohol problem, the National Institute on Alcohol Abuse and Alcoholism suggests that you look for symptoms included in what is often called the CAGE questionnaire:
Do you worry that you might need to Cut down on drinking?
Do you feel Annoyed because other people have criticized your drinking?
Do you feel Guilty about drinking?
Do you need a morning Eye opener drink to steady your nerves or to fight a hangover?
Other behavioral symptoms may include:
Having long episodes of intoxication
Having work problems or financial problems caused by drinking
Losing interest in food
Being careless about your personal appearance
Hurting yourself or someone else while you are intoxicated
Hiding liquor bottles and glasses so that other people won't know that you've been drinking
Experiencing mood or personality changes
Because too much alcohol can be toxic to internal organs, alcoholism also may cause physical symptoms, including:
Morning nausea or shaking
Signs of malnutrition due to a poor diet
Abdominal pain or diarrhea
A flushed red color to the face and palms
Numbness, weakness or tingling in the arms or legs
Unusually frequent accidental injuries, especially falls
Your doctor will ask you about your history of using alcohol and other drugs. He or she also will ask about any alcohol-related problems that you might have had at work, at home or with the law, including arrests or episodes of driving while intoxicated. Your doctor also may ask about any physical symptoms of alcoholism. Although these questions can be embarrassing to answer truthfully, your doctor should view alcoholism as an illness that can be treated, and will not respond to you as if you had a reason to be ashamed. And your doctor is in a better position to help you if you can be straightforward.
Your doctor will examine you, carefully checking for signs of poor nutrition and alcohol-related liver or nerve damage. He or she also will order blood tests to check for anemia, vitamin deficiencies and abnormal levels of liver chemicals. To help in the diagnosis of alcoholism, some doctors ask their patients to fill out a questionnaire such as the CAGE screening test (see Symptoms) or the Michigan Alcohol Screening Test (MAST).
For most alcoholics, the first alcohol-related life problem usually appears in the mid-20s to early 40s. After that, alcoholism remains a chronic, usually lifelong, illness.
There is no absolute way to prevent alcoholism. However, strong family support and solid relationships with non-drinking friends can help. Children of alcoholics can contact Alateen by calling (888) 425-2666.
Once a person has lost control of his or her drinking, it is difficult to go back to drinking moderate amounts. Therefore, the goal of treatment of alcohol dependence is usually to stop drinking alcohol completely. The first step in this process is detoxification (stopping drinking and getting treatment to prevent dangerous withdrawl symptoms). Depending on your symptoms, detoxification can be done as an outpatient, or as an inpatient in a hospital or drug treatment facility. During the withdrawal process, your doctor probably will prescribe a class of antianxiety drugs called benzodiazepines for a few days to lessen withdrawal symptoms. After that, a medication called naltrexone (ReVia) may be used to help lessen the craving for alcohol. As an alternative to naltrexone, an older medication called disulfiram (Antabuse) may be prescribed. Drinking alcohol while taking disulfiram causes nausea and vomiting. This is meant to be an incentive not to drink impulsively in response to craving.
After detoxification, most alcoholics need some form of long-term support or counseling to remain sober. Recovery programs focus on teaching a person with alcoholism about the disease, and helping him or her to learn new coping strategies to deal with the stresses of everyday life without turning to alcohol. Many patients benefit from self-help groups such as Alcoholics Anonymous (AA).
If your doctor suspects that you have any alcohol-related damage to your liver, stomach or other organs, you may need additional tests and treatments for these problems. Your doctor also will suggest a healthy diet with vitamin supplements, especially B vitamins.
When To Call A Professional
Call your doctor whenever you or someone you love has an alcohol-related problem. Remember, alcoholism is an illness that can be treated, not a sign of weakness or poor character.
About 20% of alcoholics are able to abstain from alcohol permanently without the help of formal treatment or self-help programs such as AA. Of those patients who attend AA, 44% who remain abstinent for one year probably will remain abstinent for another year. This figure increases to 91% for those who have remained abstinent and attended AA for five years or more.
On average, an alcoholic who doesn't stop drinking can expect to decrease his or her life expectancy by at least 15 years.
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
5635 Fishers Lane
Bethesda, MD 20892-9304
National Clearinghouse for Alcohol and Drug Information (NCADI)
11420 Rockville Pike
Rockville, MD 20852
Phone: (301) 770-5800
Toll-Free: (800) 729-6686
Fax: (301) 468-7394
TTY: (800) 487-4889
Alcoholics Anonymous World Services
Grand Central Station
P.O. Box 459
New York, NY 10163
Al-Anon Family Group Headquarters, Inc.
1600 Corporate Landing Parkway
Virginia Beach, VA 23454-5617
Phone: (757) 563-1600
Toll-Free: (888) 425-2666
Fax: (757) 563-1655
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