Alcoholism and alcohol abuse
Alcoholism (alcohol dependence) and alcohol abuse are two different forms of problem drinking.
Alcoholism occurs when a person shows signs of physical addiction to alcohol (for example, tolerance and withdrawal) and continues to drink, despite problems with physical health, mental health, and social, family, or job responsibilities. Alcohol may come to dominate the person's life and relationships.
In alcohol abuse, a person's drinking leads to problems, but not physical addiction.
Alcohol dependence; Alcohol abuse; Problem drinking; Drinking problem
Causes, incidence, and risk factors
There is no known cause of alcohol abuse or alcoholism. The reason why some people drink in a responsible manner and never lose control of their lives while others are unable to control their drinking is not clear.
Some people are able to gain control over their alcohol abuse before it progresses to dependence, while others are not. No one knows which heavy drinkers will be able to regain control and which will not, but the amount of alcohol one drinks can influence the likelihood of becoming dependent. Those at risk for developing alcoholism include:
- Men who have 15 or more drinks a week
- Women who have 12 or more drinks a week
- Anyone who has five or more drinks per occasion at least once a week
One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor.
Several other risk factors for alcohol abuse and dependence have been identified. For example, a person who has an alcoholic parent is more likely to become an alcoholic than a person without alcoholism in the immediate family.
Other people who may be more likely to abuse alcohol or become dependent include those who:
- Are under peer pressure, especially teens and college-aged students
- Have depression, bipolar disorder, anxiety disorders, or schizophrenia
- Have easy access to alcohol
- Have low self-esteem or problems with relationships
- Live a stressful lifestyle
- Live in a culture where there is high social acceptance of alcohol use
Research suggests that certain genes may increase the risk of alcoholism, but which genes and how they work are not known.
The prevalence of alcohol intake and related problems is rising. Data indicate that about 15% of people in the United States are problem drinkers, and about 5% to 10% of male drinkers and 3% to 5% of female drinkers could be diagnosed as alcohol dependent.
Signs of physical dependence include:
- Alcohol-related illnesses
- A need for increasing amounts of alcohol to get drunk or achieve the desired effect (tolerance)
- Memory lapses (blackouts) after heavy drinking
- Withdrawal symptoms when alcohol use is stopped
Some of the symptoms and behaviors of alcoholism include:
- Continuing to drink, even when health, work, or family are being harmed
- Drinking alone
- Episodes of violence when drinking
- Hostility when confronted about drinking
- Lack of control over drinking -- being unable to stop or reduce alcohol intake
- Making excuses to drink
- Missing work or school, or a decrease in performance
- No longer taking part in activities because of alcohol
- Need for daily or regular alcohol use to function
- Neglecting to eat
- Not caring for physical appearance
- Secretive behavior to hide alcohol use
- Shaking in the morning
For physical symptoms of alcohol abuse, see also:
Alcohol withdrawal develops because the brain adapts to the alcohol and cannot function well without the drug. See also: Alcohol withdrawal
Signs and tests
All doctors should ask their patients about their drinking. The health care provider can get a history from the family if the affected person is unwilling or unable to answer questions. A physical examination is done to identify physical problems related to alcohol use.
The following questions are used by the National Institute on Alcohol Abuse and Alcoholism to screen for alcohol abuse or dependence:
- Do you ever drive when you have been drinking?
- Do you have to drink more than before to get drunk or feel the desired effect?
- Have you felt that you should cut down on your drinking?
- Have you ever had any blackouts after drinking?
- Have you ever missed work or lost a job because of drinking?
- Is someone in your family worried about your drinking?
Tests for alcohol abuse include:
Abstinence is defined as completely avoiding the use of alcohol.
Total abstinence and avoiding high-risk situations where alcohol is present are the ideal goals for people with alcoholism. A strong social network and family support are important in achieving this.
Some problem drinkers may be successful with simply reducing the amount they drink (moderation). If moderation succeeds, the problem is solved. If not, the person should try to achieve abstinence.
Completely stopping alcohol intake and then remaining abstinent is difficult for many alcoholics. Some professionals, but not all, choose to treat alcoholism as a chronic disease. In other words, patients should expect and accept relapse, but should aim for as long a period without drinking as possible.
Many people with alcohol problems don't recognize when their drinking gets out of hand. In the past, treatment providers believed that alcoholics should be confronted about their drinking problems. Now research has shown that compassion and empathy are more effective.
The ideal approach is to help people realize how much their alcohol use is harming their life, and the lives of those around them. They can aim for a personal goal of leading a more fulfilling and sober life.
Studies find that more people enter treatment if their family members or employers are honest with them about their concerns, and try to help them see that drinking is preventing them from reaching their goals.
Withdrawal from alcohol is best done in a controlled, supervised setting in which medications relieve symptoms. This supervised withdrawal, also known as detoxification, usually takes 4 to 7 days.
Examination for other medical problems should be done. For example, liver and blood clotting problems are common in people with alcoholism.
Complications can occur with unsupervised alcohol withdrawal, such as delirium tremens (DT's), which could be fatal.
Depression or other mood or anxiety disorders may be revealed once the person is no longer on alcohol, and these should be promptly treated.
See Alcohol withdrawal for more information.
After detoxification, alcohol recovery or rehabilitation programs can help people stay off alcohol. These programs usually offer counseling, mental health support, nursing, and medical care. Therapy involves education about alcoholism and its effects.
Many of the staff members at rehabilitation centers are recovering alcoholics who serve as role models. Programs can be inpatient, where patients live in the facility during the treatment, or they can be outpatient, where patients attend the program while they live at home.
Cognitive-behavioral therapy (CBT) uses a structured teaching approach and may help people with alcoholism. Patients are given instruction and homework assignments to improve their ability to cope with basic living situations, control their behavior, and change the way they think about drinking.
Medications are sometimes prescribed to prevent relapses. They are often used along with cognitive-behavioral therapy or an ongoing recovery program.
- Acamprosate is a drug that has been shown to lower relapse rates in those who are alcohol dependent.
- Disulfiram (Antabuse) produces very unpleasant side effects if you drink even a small amount of alcohol within 2 weeks after taking the drug.
- Naltrexone (Vivitrol) decreases alcohol cravings. It is available in an injectable form.
You cannot take these medications if you are pregnant or have certain medical conditions. Long-term treatment with counseling or support groups is often necessary. The effectiveness of medication and counseling varies.
It is important that the patient has a living situation that helps support them in staying sober. Some areas have housing that provides a supportive environment for those who are trying to stay sober.
Support groups are available to help people who are dealing with alcoholism. Alcoholics Anonymous is a self-help group of recovering alcoholics that offers emotional support and a model of abstinence for people recovering from alcohol dependence. There are local chapters throughout the United States.
Members of AA:
- Are given a model of recovery by seeing the accomplishments of sober members of the group
- Have help available 24 hours a day
- Learn that it is possible to participate in social functions without drinking
Because alcoholism can also affect those around the person with the alcohol problem, family members often need counseling. Al-Anon is a support group for spouses and others who are affected by someone else's alcoholism. Alateen provides support for teenage children of alcoholics.
If you don't like the 12-step approach, there are several other support groups available. It is important to know about these other groups because, in the past, people who did not find AA helpful or were troubled by its involvement of a "Higher Power" had no alternatives.
SMART recovery uses cognitive methods to help people with alcoholism recover. LifeRing recovery and SOS are two other nonreligious programs. Women for Sobriety is a self-help group just for women -- many women with alcohol problems have different concerns than men. Moderation Management is a program for problem drinkers who want to moderate their drinking. It recommends abstinence for people who fail at moderation.
See also: Alcoholism - support group
Only 15% of people with alcohol dependence seek treatment for this disease. Drinking again after treatment is common, so it is important to maintain support systems in order to cope with any slips and ensure that they don't turn into complete reversals.
Treatment programs have varying success rates, but many people with alcohol dependence are able to maintain abstinence.
Patients who achieve total abstinence have better survival rates, mental health, and marriages. They are also more responsible parents and employees than people who continue to drink or relapse.
Alcoholism is a major social, economic, and public health problem. Alcohol is involved in more than half of all accidental deaths and almost half of all traffic deaths. A high percentage of suicides involve the use of alcohol, along with other substances.
People who abuse or are dependent on alcohol are more likely to be unemployed., involved in domestic violence, and have problems with the law (such as drinking and driving).
- Brain and nervous system complications:
- Cancers of the larynx, esophagus, liver, and colon
- Delirium tremens (DT's)
- Digestive tract disorders:
- Other complications:
- Secually transmitted diseases
Alcohol consumption during pregnancy can cause severe birth defects. The most serious is fetal alcohol syndrome, which may lead to mental retardation and behavior problems. A milder form of the condition that can still cause lifelong problems is called fetal alcohol affects.
Calling your health care provider
If you or someone you know has alcohol dependence and develops severe confusion, seizures, bleeding, or other health problems, go to the emergency room or call the local emergency number such as 911.
Educational programs and medical advice about alcohol abuse can help decrease alcohol abuse and its problems. Alcohol dependence needs more intensive management.
The National Institute on Alcohol Abuse and Alcoholism recommends that women have no more than 1 drink per day and men no more than 2 drinks per day. One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor.
Kleber HD, Weiss RD, Anton RF Jr., George TP, Greenfield SF, Kosten TR, et al. Work Group on Substance Use Disorders; American Psychiatric Association; Steering Committee on Practice Guidelines. Treatment of patients with substance use disorders, second edition. Am J Psychiatry. 2007;164:5-123.
[No authors listed] In the clinic. Alcohol use. Ann Intern Med. 2009;150:ITC3-1-ITC3-15.
O'Connor PG. Alcohol abuse and dependence. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 31.
Schuckit MA. Alcohol-use disorders. Lancet. 2009;373:492-501.
David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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