alchoholism, alchoholic, alcohalism
Introduction
For many
people, the facts about alcoholism are not clear. What is
alcoholism, exactly? How does it differ from alcohol abuse? When
should a person seek help for a problem related to his or her
drinking? This booklet was prepared to help individuals and families
answer these and other common questions about alcohol problems. The
following information explains both alcoholism and alcohol abuse,
the symptoms of each, when and where to seek help, treatment
choices, and additional helpful resources.
A Widespread Problem
For most
people who drink, alcohol is a pleasant accompaniment to social
activities. Moderate alcohol use—up to two drinks per day for men
and one drink per day for women and older people—is not harmful for
most adults. (A standard drink is one 12-ounce bottle or can of
either beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces
of 80-proof distilled spirits.) Nonetheless, a large number of
people get into serious trouble because of their drinking.
Currently, nearly 14 million Americans—1 in every 13 adults—abuse
alcohol or are alcoholic. Several million more adults engage in
risky drinking that could lead to alcohol problems. These patterns
include binge drinking and heavy drinking on a regular basis. In
addition, 53 percent of men and women in the United States report
that one or more of their close relatives have a drinking
problem.
The
consequences of alcohol misuse are serious—in many cases, life
threatening. Heavy drinking can increase the risk for certain
cancers, especially those of the liver, esophagus, throat, and
larynx (voice box). Heavy drinking can also cause liver cirrhosis,
immune system problems, brain damage, and harm to the fetus during
pregnancy. In addition, drinking increases the risk of death from
automobile crashes as well as recreational and on-the-job injuries.
Furthermore, both homicides and suicides are more likely to be
committed by persons who have been drinking. In purely economic
terms, alcohol-related problems cost society approximately $185
billion per year. In human terms, the costs cannot be calculated.
What Is Alcoholism?
Alcoholism, also known as
“alcohol dependence,” is a disease that includes four
symptoms:
Craving:
A strong need, or compulsion, to drink.
Loss of
control: The inability to limit one’s drinking on any given
occasion.
Physical
dependence: Withdrawal symptoms, such as nausea, sweating,
shakiness, and anxiety, occur when alcohol use is stopped after a
period of heavy drinking.
Tolerance: The need to drink greater amounts of alcohol in
order to “get high.”
Although
some people are able to recover from alcoholism without help, the
majority of alcoholics need assistance. With treatment and support,
many individuals are able to stop drinking and rebuild their
lives.
Many
people wonder why some individuals can use alcohol without problems
but others cannot. One important reason has to do with genetics.
Scientists have found that having an alcoholic family member makes
it more likely that if you choose to drink you too may develop
alcoholism. Genes, however, are not the whole story. In fact,
scientists now believe that certain factors in a person’s
environment influence whether a person with a genetic risk for
alcoholism ever develops the disease. A person’s risk for developing
alcoholism can increase based on the person’s environment, including
where and how he or she lives; family, friends, and culture; peer
pressure; and even how easy it is to get alcohol.
What Is Alcohol Abuse?
Alcohol
abuse differs from alcoholism in that it does not include an
extremely strong craving for alcohol, loss of control over drinking,
or physical dependence. Alcohol abuse is defined as a pattern of
drinking that results in one or more of the following situations
within a 12-month period:
Failure to
fulfill major work, school, or home responsibilities;
Drinking in
situations that are physically dangerous, such as while driving a
car or operating machinery;
Having recurring
alcohol-related legal problems, such as being arrested for driving
under the influence of alcohol or for physically hurting someone
while drunk; and
Continued
drinking despite having ongoing relationship problems that are
caused or worsened by the drinking.
Although
alcohol abuse is basically different from alcoholism, many effects
of alcohol abuse are also experienced by alcoholics.
What Are the Signs of a Problem?
How can
you tell whether you may have a drinking problem? Answering the
following four questions can help you find out:
Have
you ever felt you should cut down on your drinking?
Have
people annoyed you by criticizing your drinking?
Have
you ever felt bad or guilty about your drinking?
Have you ever
had a drink first thing in the morning (as an “eye opener”) to
steady your nerves or get rid of a hangover?
One “yes”
answer suggests a possible alcohol problem. If you answered “yes” to
more than one question, it is highly likely that a problem exists.
In either case, it is important that you see your doctor or other
health care provider right away to discuss your answers to these
questions. He or she can help you determine whether you have a
drinking problem and, if so, recommend the best course of
action.
Even if
you answered “no” to all of the above questions, if you encounter
drinking-related problems with your job, relationships, health, or
the law, you should seek professional help. The effects of alcohol
abuse can be extremely serious—even fatal—both to you and to
others.
The Decision To Get Help
Accepting
the fact that help is needed for an alcohol problem may not be easy.
But keep in mind that the sooner you get help, the better are your
chances for a successful recovery.
Any
concerns you may have about discussing drinking-related problems
with your health care provider may stem from common misconceptions
about alcoholism and alcoholic people. In our society, the myth
prevails that an alcohol problem is a sign of moral weakness. As a
result, you may feel that to seek help is to admit some type of
shameful defect in yourself. In fact, alcoholism is a disease that
is no more a sign of weakness than is asthma. Moreover, taking steps
to identify a possible drinking problem has an enormous payoff—a
chance for a healthier, more rewarding life.
When you
visit your health care provider, he or she will ask you a number of
questions about your alcohol use to determine whether you are having
problems related to your drinking. Try to answer these questions as
fully and honestly as you can. You also will be given a physical
examination. If your health care provider concludes that you may be
dependent on alcohol, he or she may recommend that you see a
specialist in treating alcoholism. You should be involved in any
referral decisions and have all treatment choices explained to you.
Alcoholism Treatment
The type
of treatment you receive depends on the severity of your alcoholism
and the resources that are available in your community. Treatment
may include detoxification (the process of safely getting alcohol
out of your system); taking doctor-prescribed medications, such as
disulfiram (Antabuse) or naltrexone (ReVia™),
to help prevent a return (or relapse) to drinking once drinking has
stopped; and individual and/or group counseling. There are promising
types of counseling that teach alcoholics to identify situations and
feelings that trigger the urge to drink and to find new ways to cope
that do not include alcohol use. These treatments are often provided
on an outpatient basis.
Because
the support of family members is important to the recovery process,
many programs also offer brief marital counseling and family therapy
as part of the treatment process. Programs may also link individuals
with vital community resources, such as legal assistance, job
training, childcare, and parenting classes.
Alcoholics Anonymous
Virtually
all alcoholism treatment programs also include Alcoholics Anonymous
(AA) meetings. AA describes itself as a “worldwide fellowship of men
and women who help each other to stay sober.” Although AA is
generally recognized as an effective mutual help program for
recovering alcoholics, not everyone responds to AA’s style or
message, and other recovery approaches are available. Even people
who are helped by AA usually find that AA works best in combination
with other forms of treatment, including counseling and medical
care.
Can Alcoholism Be Cured?
Although
alcoholism can be treated, a cure is not yet available. In other
words, even if an alcoholic has been sober for a long time and has
regained health, he or she remains susceptible to relapse and must
continue to avoid all alcoholic beverages. “Cutting down” on
drinking doesn’t work; cutting out alcohol is necessary for a
successful recovery.
However,
even individuals who are determined to stay sober may suffer one or
several “slips,” or relapses, before achieving long-term sobriety.
Relapses are very common and do not mean that a person has failed or
cannot recover from alcoholism. Keep in mind, too, that every day
that a recovering alcoholic has stayed sober prior to a relapse is
extremely valuable time, both to the individual and to his or her
family. If a relapse occurs, it is very important to try to stop
drinking once again and to get whatever additional support you need
to abstain from drinking.
Help for Alcohol Abuse
If your
health care provider determines that you are not alcohol dependent
but are nonetheless involved in a pattern of alcohol abuse, he or
she can help you to:
Examine
the benefits of stopping an unhealthy drinking pattern.
Set a drinking
goal for yourself. Some people choose to abstain from alcohol.
Others prefer to limit the amount they drink.
Examine the
situations that trigger your unhealthy drinking patterns, and
develop new ways of handling those situations so that you can
maintain your drinking goal.
Some
individuals who have stopped drinking after experiencing
alcohol-related problems choose to attend AA meetings for
information and support, even though they have not been diagnosed as
alcoholic.
Genetics:
Alcoholism is a complex disease. Therefore, there are likely to be
many genes involved in increasing a person’s risk for alcoholism.
Scientists are searching for these genes, and have found areas on
chromosomes where they are probably located. Powerful new techniques
may permit researchers to identify and measure the specific
contribution of each gene to the complex behaviors associated with
heavy drinking. This research will provide the basis for new
medications to treat alcohol-related problems.
Treatment: Researchers have made considerable
progress in evaluating commonly used therapies and in developing new
types of therapies to treat alcohol-related problems. One
large-scale study sponsored by NIAAA found that each of three
commonly used behavioral treatments for alcohol abuse and
alcoholism—motivation enhancement therapy, cognitive-behavioral
therapy, and 12-step facilitation therapy—significantly reduced
drinking in the year following treatment. This study also found that
approximately one-third of the study participants who were followed
up either were still abstinent or were drinking without serious
problems 3 years after the study ended. Other therapies that have
been evaluated and found effective in reducing alcohol problems
include brief intervention for alcohol abusers (individuals who are
not dependent on alcohol) and behavioral marital therapy for married
alcohol-dependent individuals.
Medications development:
Naltrexone, which targets the brain’s reward
circuits, is the first medication approved to help maintain sobriety
after detoxification from alcohol since the approval of disulfiram
(Antabuse) in 1949. The use of acamprosate, an
anticraving medication that is widely used in Europe, is based on
neuroscience research. Researchers believe that acamprosate works on
different brain circuits to ease the physical discomfort that occurs
when an alcoholic stops drinking. Acamprosate should be approved for
use in the United States in the near future, and other medications
are being studied as well.
Combined medications/behavioral therapies: Researchers
have found that available medications work best with behavioral
therapy. Thus, NIAAA has initiated a large-scale clinical trial to
determine which of the currently available medications and which
behavioral therapies work best together. Naltrexone and acamprosate
will each be tested separately with different behavioral therapies.
These medications will also be used together to determine if there
is some interaction between the two that makes the combination more
effective than the use of either one alone.
In
addition to these efforts, NIAAA is sponsoring promising research in
other vital areas, such as fetal alcohol syndrome, alcohol’s effects
on the brain and other organs, aspects of drinkers’ environments
that may contribute to alcohol abuse and alcoholism, strategies to
reduce alcohol-related problems, and new treatment techniques.
Together, these investigations will help prevent alcohol problems;
identify alcohol abuse and alcoholism at earlier stages; and make
available new, more effective treatment approaches for individuals
and families.
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
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For more
information on alcohol abuse and alcoholism, contact the following
organizations:
Al-Anon Family Group Headquarters, Inc.
1600 Corporate
Landing Parkway
Virginia Beach, VA
23454–5617
Phone: (757) 563–1600;
Fax: (757) 563–1655
Email: WSO@al-anon.org
Web: http://www.al-anon.alateen.org
Makes
referrals to local Al-Anon groups, which are support groups for
spouses and other significant adults in an alcoholic person’s life.
Also makes referrals to Alateen groups, which offer support to
children of alcoholics. Free informational materials and locations
of Al-Anon or Alateen meetings worldwide can be obtained by calling
the toll-free number (888) 425–2666 from the United States or
Canada, Monday through Friday, 8 a.m.–6 p.m. (e.s.t.).
Alcoholics Anonymous (AA) World Services, Inc.
475 Riverside Drive, 11th Floor
New York, NY 10115
Phone: (212) 870–3400;
Fax: (212) 870–3003
Email: via AA’s
Web: http://www.aa.org
Makes
referrals to local AA groups and provides informational materials on
the AA program. Many cities and towns also have a local AA office
listed in the telephone book. All communication should be
directed to AA’s mailing address: AA World Services, Inc., Grand
Central Station, P.O. Box 459, New York, NY
10163.
National Council on Alcoholism and Drug Dependence, Inc. (NCADD)
20 Exchange Place, Suite 2902
New York, NY 10005
Phone: (212) 269–7797;
Fax: (212) 269–7510
Email: national@ncadd.org
HOPE LINE: (800) NCA–CALL (24-hour Affiliate referral)
Web: http://www.ncadd.org
Offers
educational materials and information on alcoholism. Provides phone
numbers of local NCADD Affiliates (who can provide information on
local treatment resources) via the above toll-free, 24-hour HOPE
LINE.
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Scientific Communications Branch
6000 Executive Boulevard,Willco Building, Suite 409
Bethesda, MD 20892–7003
Phone: (301) 443–3860;
Fax: (301) 480–1726
Email: niaaaweb-r@exchange.nih.gov
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