Alcoholism is an illness marked
by consumption of alcoholic beverages at a level that interferes with physical
or mental health, and social, family, or occupational responsibilities.
Alcholoism is divided into 2 categories: dependence and abuse.
People with alcohol dependence,
the most severe alcohol disorder, usually experience tolerance and withdrawal.
Tolerance is a need for markedly increased amounts of alcohol to achieve
intoxication or the desired effect. Withdrawal occurs when alcohol is
discontinued or intake is decreased. Alcohol dependents spend a great deal of
time drinking alcohol, and obtaining it.
Alcohol abusers are "problem
drinkers", that is, they may have legal problems, such as drinking and driving,
or binge drinking (drinking 6 or more drinks on one occasion). People who are
dependent on or abuse alcohol return to its use despite evidence of physical or
psychological problems. Those with dependence have more severe problems and a
greater compulsion to drink.
Causes, incidence, and risk factors
Alcoholism is a type of drug
addiction. There is both physical and psychological dependence with this
addiction. Physical dependence reveals itself by withdrawal symptoms when
alcohol intake is interrupted, tolerance to the effects of alcohol, and evidence
of alcohol-associated illnesses.
Alcohol affects the central
nervous system as a depressant, resulting in a decrease of activity, anxiety,
tension, and inhibitions. Even a few drinks can result in behavioral changes, a
slowing in motor performance, and a decrease in the ability to think clearly.
Concentration and judgment become impaired. In excessive amounts, intoxication
may result.
Alcohol also affects other body
systems. Irritation of the gastrointestinal tract can occur with erosion of the
lining of the esophagus and stomach causing nausea and vomiting, and possibly
bleeding. Vitamins are not absorbed properly, which can lead to nutritional
deficiencies with the long-term use of alcohol. Liver disease, called alcoholic
hepatitis, may also develop and can progress to cirrhosis. The heart muscle may
be affected. Sexual dysfunction may also occur, causing problems with erections
in men and cessation of menstruation in women.
Alcohol affects the nervous
system and can result in nerve damage and severe memory loss. Chronic alcohol
use also increases the risk of cancer of the larynx, esophagus, liver, and
colon. Alcohol consumption during pregnancy can cause severe birth defects. The
most serious is fetal alcohol syndrome, which may result in mental retardation
and behavior problems. A milder form of the condition which can still cause
lifelong impairment is called fetal alcohol affects.
The social consequences of
problem drinking and alcohol dependence can be as serious as the medical
problems. People who abuse or are dependent on alcohol have a higher incidence
of unemployment, domestic violence, and problems with the law. About half of all
traffic deaths are related to alcohol use.
The development of dependence on
alcohol may occur over a period of years, following a relatively consistent
pattern. At first, a tolerance of alcohol develops. This results in a person
being able to consume a greater quantity of alcohol before its adverse effects
are noticed. Memory lapses (black-outs) relating to drinking episodes may follow
tolerance. Then, people may lose control over drinking and find it difficult or
impossible to stop if they try. The most severe drinking behavior includes
prolonged binges of drinking with associated mental or physical complications.
Some people are able to gain control over their dependence in earlier phases
before a total lack of control occurs. The problem is, no one knows which heavy
drinkers will be able to regain control and which will not.
Withdrawal develops because the
brain has physically adapted to the presence of alcohol and cannot function
adequately in the absence of the drug. Symptoms of withdrawal may include
elevated temperature, increased blood pressure, rapid heart rate, restlessness,
anxiety, psychosis, seizures, and rarely even death.
There is no known common cause of
alcoholism. However, several factors may play a role in its development. A
person who has an alcoholic parent is more likely to become an alcoholic than a
person without alcoholism in the immediate family. Research suggests that
certain genes may increase the risk of alcoholism but which genes or how they
exert their influence is controversial. Psychological factors may include a need
for relief of anxiety, ongoing depression, unresolved conflict within
relationships, or low self-esteem. Social factors include availability of
alcohol, social acceptance of the use of alcohol, peer pressure, and stressful
lifestyles.
The incidence of alcohol intake
and related problems is increasing. Data from many sources indicate that about
15% of the population in the United States are problem drinkers, and
approximately 5% to 10% of male drinkers and 3% to 5% of female drinkers could
be diagnosed as alcohol dependent (12.5million people).
Symptoms
Men who consume 15 or more drinks
a week, women who consume 12 or more drinks a week, or anyone who consumes 5 or
more drinks per occasion at least once a week are all at risk for developing
alcoholism. (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).
The following questions are used
by the National Institute on Alcohol Abuse and Alcoholism to screen for alcohol
abuse or dependence:
- Have you felt that you should
cut down on your drinking?
- Do you ever drive when you
have been drinking?
- Is someone in your family
concerned about your drinking?
- Have you ever had any
blackouts after drinking?
- Have you ever been absent from
work or lost a job because of drinking?
- Do you have to drink more than
before to achieve intoxication or the desired effect?
Some of the symptoms associated
with alcoholism include
- Solitary drinking
- Making excuses to drink
- Need for daily or frequent use
of alcohol for adequate function
- Lack of control over drinking,
with inability to discontinue or reduce alcohol intake
- Episodes of violence
associated with drinking
- Secretive behavior to hide
alcohol related behavior
- Hostility when confronted
about drinking
- Neglect of food intake
- Neglect of physical appearance
- Nausea and vomiting
- Shaking in the morning
- Abdominal pain
- Numbness and tingling
- Confusion
Symptoms may vary.
Alcohol withdrawal symptoms may
vary from mild to severe:
- Rapid heart rate and sweating
- Restlessness or agitation
- Loss of appetite, nausea, or
vomiting
- Confusion or hallucinations
- Tremors and seizures
Signs and tests
All physicians should ask their
patients about their drinking. A history may be obtained from family if the
affected person is unwilling or unable to answer questions. A physical
examination is performed to identify physical problems related to alcohol use.
- A toxicology screen or blood
alcohol level confirms recent alcohol ingestion, which does not necessarily
confirm alcoholism.
- Liver function tests can be
elevated. GGPT (glutaryl transaminase) is often elevated more than other liver
function tests.
- CBC (complete blood count) -
MCV can be elevated (mean corpuscular volume or size of the red blood cells).
- Serum magnesium, uric acid,
total protein, and folate tests may be abnormal.
Treatment
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 denial of their
drinking problems, but now research has shown that compassionate and empathetic
counseling is more effective.
Three general steps are involved
in treating the alcoholic once the disorder has been diagnosed: intervention,
detoxification, and rehabilitation. Research finds that the traditional
confrontational intervention - where the employer or family members surprise the
alcoholic and threaten consequences if treatment is not begun - is NOT
effective. 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 to
see that drinking is preventing them from reaching their goals.
Once the problem has been
recognized, total abstinence from alcohol is required for those who are
dependent; for those who are problem drinkers, moderation may be successful.
Since many alcoholics initially refuse to believe that their drinking is out of
control, a trial of moderation can often be an effective way to deal with the
problem. If it succeeds, the problem is solved. If not, the person is usually
ready to try abstinence. Because alcoholism affects the people closely related
to the alcoholic person, treatment for family members through counseling is
often necessary.
Detoxification is the first phase
of treatment. Withdrawal from alcohol is done in a controlled, supervised
setting in which medications relieve symptoms. Detoxification usually takes 4 to
7 days. Examination for other medical problems is necessary. For example, liver
and blood clotting problems are common. A balanced diet with vitamin supplements
is important. Complications associated with the acute withdrawal of alcohol may
occur, such as delirium tremens (DT's), which could be fatal. Depression or
other underlying mood disorders should be evaluated and treated. Often, alcohol
abuse develops from efforts to self-treat an illness.
Alcohol recovery or
rehabilitation programs support the affected person after detoxification to
maintain abstinence from alcohol. Counseling, psychological support, nursing,
and medical care are usually available within these programs. Education about
the disease of alcoholism and its effects is part of the therapy. Many of the
professional staff involved in rehabilitation centers are recovering alcoholics
who serve as role models. Programs can be either inpatient, with the patient
residing in the facility during the treatment, or outpatient, with the patient
attending the program while they live at home.
Medications are sometimes
prescribed to prevent relapses. Naltrexone (an opioid antagonist) decreases
alcohol cravings. Disulfiram (Antabuse) works by producing very unpleasant side
effects if even a small amount of alcohol is ingested within 2 weeks after
taking the drug. These medications are not given during pregnancy or if the
person has certain medical conditions. Long-term treatment with counseling or
support groups is often necessary. The effectiveness of medication and
counseling varies.
Alcoholics Anonymous is a
self-help group of recovering alcoholics that offers emotional support and an
effective model of abstinence for people recovering from alcohol dependence.
There are more than 1 million members worldwide, and local chapters are found
throughout the United States.
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. See alcoholism - support
group.
For those who don't like the
12-step approach, there are several other support groups available. It is
important that people dealing with alcohol problems know about these other
groups because in the past, those who did not find AA helpful or were troubled
by its requirement of submission to a "Higher Power" had no alternatives.
SMART recovery uses
research-based cognitive techniques to help alcoholics recover. LifeRing
recovery and SOS are two other secular programs. Women For Sobriety is a
self-help group just for women - many female alcoholics have different concerns
than men. Moderation Management is a program for problem drinkers seeking to
moderate their drinking - it recommends abstinence for those who fail at such
attempts.
