Alcoholism

Definition

Alcoholism is a chronic (long-term) disease in which people become

physically dependent on alcohol and cannot control how much they

drink even though their drinking is damaging their health, schoolwork

or job performance, and friendships or family relationships. It is a

progressive disease, which means that without treatment, it gets worse

over time.

Some doctors use the term

that causes problems in the person

dependence on alcohol or complete loss of control over drinking.

Binge drinking refers to consuming a number of drinks in a row on a

single occasion, usually five drinks for men and four for women. A drink

is defined as one 12-ounce beer, one 4- to 5-ounce glass of wine, or one

mixed drink containing 1.5 ounces of whiskey or other liquors. Some

binge drinkers may claim that they do not have a problem with alcohol

because they do not drink every night.

Description

Alcoholism is a serious disease not only for the damage it does to the

health and lives of alcoholics but also to the burden it places on society

as a whole. It is the third leading cause of preventable death in the United

States, after smoking and obesity. Alcoholism is responsible for 85,000

deaths in the United States each year. About one in every twelve adults

in the United States

on it.

Around the world, alcoholism is responsible for a percentage of various

disease conditions:

—17.6 million people—abuse alcohol or are dependent

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Cirrhosis of the liver: 32 percent

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Motor vehicle crashes: 20 percent

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Cancer of the esophagus: 29 percent

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Liver cancer: 25 percent

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Stroke: 10 percent

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Homicide: 24 percent

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Women who drink during pregnancy are at risk of having children

who are mentally retarded and underweight at birth. This condition,

known as fetal alcohol syndrome or FAS, affects one or two of every

1,000 babies born in the United States each year.

There is no single way that people become alcoholics. One reason

why the experience of the disease is so difficult to describe is that the

speed at which it develops and its consequences vary from person to

person. Some people say that they became alcoholics after their first few

drinks. Others drank responsibly for years and then became dependent

on alcohol in midlife or even old age. In addition, some people get help

before they get into serious trouble from drinking. They are sometimes

called

drinking while they still have a job or family. Alcoholics who have

found themselves in trouble with the law, are homeless, or have lost

their jobs and families sometimes refer to themselves as

“high-bottom” alcoholics—that is, they “hit bottom” with their“low-bottom”alcoholics.

Demographics

According to a study of adults in the United States conducted by the

National Longitudinal Alcohol Epidemiologic Study, 44 percent of

American adults are social drinkers; 22 percent drank at one time but

do not drink alcohol at present; and 34 percent have always abstained

from alcohol. Between 8 and 10 percent of adults are diagnosed with

alcohol abuse or dependency in an average year.

Risk factors for alcoholism include:

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of alcoholism, a study done in 2006 estimated that genetic factors

account for 50 to 60 percent of a person

abuse.

Genetics. Although no specific genes have been identified as causes’s vulnerability to alcohol

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Family history of alcoholism.

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drink before age sixteen are at higher risk of alcohol abuse.

The age at which a person started to drink. People who began to

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than women. Women, however, do not metabolize alcohol

as efficiently as men and can become intoxicated on smaller

amounts of alcohol than men of the same weight.

Gender. Men are two to three times more likely to become alcoholics

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alcohol abuse, followed by Hispanics, Caucasians, African Americans,

and Asian Americans.

Race and ethnicity. Native Americans are at increased risk of

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A history of depression or other mental disorders.

Causes and Symptoms

Alcoholism is the end result of a combination of factors that interact in

ways that are unique to each person with the disorder:

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the cases.

Genetic factors. These are thought to account for at least half of

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cope with anxiety, depression, posttraumatic stress disorder, or other

painful feelings. This misuse of alcohol is called self-medication.

Psychological and emotional stress. Some people turn to alcohol to

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look grownup or because their friends are encouraging them to

drink. In some groups, heavy drinking may be seen as proof of

masculinity. In addition, many films and television shows make

drinking look glamorous or sophisticated.

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chemicals in the brain, leading the person to crave alcohol either

to get rid of bad feelings or to restore good feelings. Some people

find that they eventually need alcohol just to feel normal.

The main symptomof alcoholism is denial; that is, alcoholics deny that

they have a drinking problem until a series of health problems, family arguments,

job losses, arrests, or other negative consequences force them to

admit their drinking is out of control. Other symptoms commonly include:

Body chemistry. Long-term drinking alters the levels of various

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Drinking alone or in private.

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Hiding alcohol in the car, office, or other secret places.

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Feeling irritated or angry if unable to have a drink at the usual time.

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Gulping drinks quickly or drinking just to feel normal.

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Having problems with employment, finances, or the law.

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get the same effects.

Building up tolerance to alcohol; that is, needing larger amounts to

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a few days. These symptoms include shaking, insomnia, nausea,

and vomiting.

Having withdrawal symptoms after going without alcohol for

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Feeling a need or compulsion to drink.

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remember what happened while he or she was drinking but did not

pass out.

Having blackouts. A blackout describes when someone is unable to

Diagnosis

The diagnosis of alcoholism is usually made on the basis of the patient

history and a review of his or her answers to screening questionnaires. The

two screeners most often used are called the CAGE and AUDIT questionnaires

(see sidebar). They can be completed in the doctor

who answer yes to two of the four CAGE questions are seven times more

likely to have a drinking problem than people in the general population.

The AUDIT questionnaire assigns points ranging from zero to four

depending on the frequency of the behaviors mentioned in the questions.

A score of eight or higher indicates a high likelihood of alcoholism.

Although there are blood and urine tests that can detect the presence

of alcohol or its breakdown products in the body, these tests reflect only

whether the person was drinking at the time the test was given. Such tests

are not useful in detecting long-term drinking patterns.

In general, doctors often miss the diagnosis of alcoholism in their

patients. This occurs because of the patient

that the doctor will tell his or her employer or other family members.

’s denial or the patient’s fear

Treatment

Treatment of alcoholism is important not only for the disease itself but

also as a necessary first step toward treating other disorders. For example,

psychiatrists will not treat someone for a mental disorder like bipolar disorder

or depression as long as the person is still drinking. Patients with

liver disease and other physical problems related to drinking also need

to be treated for alcoholism before their physical health will improve.

Treatment of alcoholism usually proceeds in several stages.

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to get help. It may be done by family members, the person

employer, a doctor, or others concerned about the person. The

reason that intervention is usually necessary is that only 15 percent

of alcoholics seek help on their own.

Intervention. Intervention is the term used for persuading the alcoholic’s

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takes between four and seven days. The alcoholic is placed in a

treatment center where he or she is given medications (usually

tranquilizers) to control the symptoms of withdrawal from alcohol.

These symptoms may include sweating, nausea, vomiting, seizures,

or a severe reaction called delirium tremens (also called the DTs).

In delirium tremens, the person may hallucinate and have very high

blood pressure and rapid breathing. It can be fatal if not treated.

Detoxification. Sometimes nicknamed detox, this is a process that

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about the effects of alcohol, support groups, psychological

counseling, and an emphasis on getting the patient to accept the

truth about his or her alcohol dependence.

Rehabilitation. Rehabilitation for alcoholics includes patient education

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Antabuse and Campral, which work either by making the person

feel sick if he or she drinks or by lowering the craving for alcohol.

These drugs work best in highly motivated patients. However, they

are not magic cures for alcoholism.

Most doctors think that alcoholics should completely give up

drinking because of the danger of relapse (falling back into out-of-control

drinking). Although a few people who are not physically dependent

on alcohol but have found themselves in trouble for abusing it can

sometimes manage by simply cutting back on the amount they drink,

complete abstinence is the best option for recovery.

Prognosis

There is no cure for alcoholism. Recovery requires lifelong commitment to

abstaining from alcohol and being honest with oneself. The prognosis is

better for alcoholics who do not smoke and are not addicted to other drugs.

Nonetheless, only about 30 percent of alcoholics maintain their recovery

over the long term. Studies have shown that about half of those who complete

a detoxification program relapse within six to twelve months.

Prevention

People who have a family history of alcoholism can lower their risk of

becoming alcoholics by learning about alcoholism and building a strong

social support network. Parents can help by setting an example of responsible

use of alcohol and talking openly about the physical and mental

dangers of heavy drinking.

The Future

According to statistics kept by the National Institutes of Health (NIH),

the rate of alcoholism and alcohol abuse is rising in the United States

and other developed countries. Some of the reasons for this trend are

the easy availability of alcohol (including homemade alcoholic beverages);

the role of the mass media in promoting drinking; and the weakening of

family ties.

SEE ALSO Child abuse; Fetal alcohol syndrome; Smoking; StrokeMedications. There are several drugs, the best-known of which are’s’s office. PeopleSocial and cultural factors. People may begin to drink heavily toSuicide: 11 percent“alcohol abuse” to describe heavy drinking’s life but has not yet led to physical

Alcoholism