You know a person is abusing alcohol when life at work and at home are seriously disrupted. It's a chronic disease that hits younger adults more prevalently than older ones.
Alcohol abuse is defined as a pattern of drinking that results in one or more of the following situations within a 12-month period:
Alcoholism, or alcohol dependence, is the most severe form of alcohol abuse. It is a chronic disease characterized by the consumption of alcohol at a level that interferes with physical and mental health and with family and social responsibilities. An alcoholic will continue to drink despite serious health, family, or legal problems.
Alcoholism is influenced by both genetic and environmental factors. Alcoholism is chronic: It lasts a person's lifetime. It usually follows a predictable course and has recognizable symptoms.
Alcohol abuse and alcoholism cut across gender, race, and ethnicity. Nearly 14 million people in the United States are dependent on alcohol. More men than women are alcohol dependent or have alcohol problems. Alcohol problems are highest among young adults ages 18-29 and lowest among adults ages 65 and older. Also, people who start drinking at an early age have a greater chance of developing alcohol problems at some point in their lives.
Alcohol's effects vary with age. Slower reaction times, problems with hearing and seeing, and a lower tolerance to alcohol's effects put older people at higher risk for falls, car crashes, and other types of injuries that may result from drinking. More than 150 medications interact harmfully with alcohol.
Alcohol also affects women differently than men. Women become more impaired than men do after drinking the same amount of alcohol, even when differences in body weight are taken into account. In addition, chronic alcohol abuse takes a heavier physical toll on women than on men. Alcohol dependence and related medical problems, such as brain, heart, and liver damage, progress more rapidly in women.
Alcoholism, also known as alcohol dependence, is a disease that includes:
Alcohol abuse differs from alcohol dependence in that
Answering the following four questions can help you find out if you or a loved one has a drinking problem:
One yes answer suggests a possible alcohol problem. A yes to more than one question indicates that it is highly likely a problem exists. In either case, it is important to consult a doctor or other health care provider immediately to determine if you have a drinking problem and, if so, initiate the best course of action.
Even if you answered no to all of the above questions, you may still need help. You should seek a professional if you encounter drinking-related problems with your job, relationships, health, or the law. The effects of alcohol abuse can be extremely serious—fatal—to you and to others.
The risk for developing alcoholism is influenced by both genetic and environmental factors.
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.
Most alcoholics need help to recover from disease. In most cases, relapse rates are high. However, with support and treatment, many people are able to stop drinking and rebuild their lives. Alcoholism treatment programs use both counseling and medications to help a person stop drinking.
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 four to seven 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 from alcohol may occur, such as delirium tremens (DT's), which could be fatal. Depression or other underlying mood disorders should be evaluated and treated, as alcohol abuse often 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.
Research supported by the National Institute of Alcohol Abuse and Alcoholism (NIAAA) has made considerable progress in evaluating commonly used therapies and 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—enhancement therapy, cognitive-behavioral therapy, and 12-step therapy—reduced drinking in the year following treatment. Three years after the study ended, approximately one-third of the study participants were either still abstinent or drinking without serious problems. 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 therapy.
It is also important to remember that oftentimes other psychiatric conditions, for example depression or bipolar disorder, may coexist with alcoholism. Therefore, coexisting or underlying disorders should be recognized and treated. Individuals suffering from other underlying psychiatric conditions may use alcohol as a form of self-medication. If this is the case, proper diagnosis of any coexisting conditions is all the more valuable.
Though several medications can help treat alcoholism, there is no "magic bullet." No single medication is available that works in every case and/or in every person. Developing new and more effective medications to treat alcoholism remains a high priority for researchers.
Three oral medications—disulfiram (Antabuse®), naltrexone (Depade®, ReVia®), and acamprosate (Campral®)—are currently approved to treat alcohol dependence. In addition, an injectable, long-acting form of naltrexone (Vivitrol®) is available. These medications have been shown to help people with dependence reduce their drinking, avoid relapse to heavy drinking, and achieve and maintain abstinence. Naltrexone acts in the brain to reduce craving for alcohol after someone has stopped drinking. Acamprosate is thought to work by reducing symptoms that follow lengthy abstinence, such as anxiety and insomnia. Disulfiram discourages drinking by making the person taking it feel sick after drinking alcohol.
Other types of drugs are available to help manage symptoms of withdrawal (such as shakiness, nausea, and sweating) if they occur after someone with alcohol dependence stops drinking. Early recognition of these symptoms and immediate treatment can prevent some of the symptoms or drastically limit severity.
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. 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.
Seeking Help for an Unwilling Alcoholic
An alcoholic can't be forced to get help except under certain circumstances, such as a violent incident that results in court-ordered treatment or medical emergency. But you don't have to wait for someone to "hit rock bottom." Many alcoholism treatment specialists suggest the following steps to help an alcoholic:
Alcoholism treatment works for many people. But just like any chronic disease, there are varying levels of success when it comes to treatment. Some people stop drinking and remain sober. Others have long periods of sobriety with bouts of relapse. And still others cannot stop drinking for any length of time. With treatment, one thing is clear, the longer a person abstains from alcohol the more likely he or she will stay sober.