Alcohol Abuse

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.

Definition

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
  • Continued drinking despite having ongoing relationship problems that are caused or worsened by the drinking.

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.

Symptoms

Alcohol Dependence

Alcoholism, also known as alcohol dependence, is a disease that includes:

  • Craving: A strong need, or compulsion, to drink
  • Loss of control: The inability to limit one's drinking on any given occasion
  • Physical dependence: Includes evidence of tolerance and withdrawal
  • Tolerance: The need to drink greater amounts of alcohol in order to get drunk
  • Withdrawal symptoms: Nausea, vomiting, sweating, shakiness, hallucinations (visual or auditory), anxiety, and even seizures. These symptoms can occur in individuals who have been heavy drinkers over a period of time.

Alcohol Abuse

Alcohol abuse differs from alcohol dependence in that

  1. It does not include an extremely strong craving for alcohol
  2. A person may experience some loss of control over drinking, which may lead to problems with work, home, school, relationships, or the law
  3. It usually does not include signs of physical dependence

Answering the following four questions can help you find out if you or a loved one has a drinking problem:

  • 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 to steady your nerves or to get rid of a hangover?

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.

Side effects

  • Higher incidence of unemployment
  • Higher incidence of domestic violence
  • Legal problems

Health Hazards

  • Increased incidence of cancer, particularly cancer of the larynx, esophagus, liver, and colon
  • Alcoholic hepatitis, an acute syndrome reported by patients who have ingested about 100 grams of alcohol (about eight ounces of 100-proof whiskey, 30 ounces of wine, or eight 12-ounce cans of beer) daily for over one year. Symptoms can include fever, jaundice, and enlarged liver
  • Acute and/or chronic pancreatitis—inflammatory disease of the pancreas
  • Cirrhosis of the liver—alcohol abuse can cause alcoholic hepatitis, which then can lead to cirrhosis, or fibrotic changes in the liver
  • Alcoholic neuropathy—or degenerative changes in the nervous system affecting nerves responsible for sensation and movement
  • Alcoholic cardiomyopathy
  • High blood pressure
  • Nutritional deficiencies—vitamin B12, folate, and thiamine
  • High blood pressure
  • Erectile dysfunction
  • Cessation of menses
  • Fetal alcohol syndrome in the children of women who drink during pregnancy
  • Depression
  • Traffic fatalities
  • Accidental deaths
  • Increased risk of suicide
  • Alcohol dementia
  • Wernicke-Korsakoff syndrome or Wernicke's encephalopathy: a syndrome of central nervous system changes resulting from thiamine deficiency where an individual becomes confused, loses balance while walking, and shows loss of vision.

Causes

The risk for developing alcoholism is influenced by both genetic and environmental factors.

Treatments

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.

Medication

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.

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. 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:

  • Stop all "coverups." Family members often make excuses or try to protect the alcoholic from the results of his or her drinking. It is important to stop covering for the alcoholic so that he or she experiences the full consequences of drinking.
  • The best time to talk to the drinker about his or her drinking is shortly after an alcohol-related problem has occurred—a serious family argument or an accident. Choose a time when he or she is sober, both of you are fairly calm, and you have a chance to talk in private.
  • Be specific. Tell the family member that you are worried about his or her drinking. Use examples of the ways in which the drinking has caused problems, including the most recent incident.
  • State the results. Explain to the drinker what you will do if he or she doesn't seek help. What you say may range from refusing to go with the person to any social activity where alcohol will be served to moving out of the house. Do not make any threats you are not prepared to carry out.
  • Get help. Gather information in advance about treatment options in your community. If the person is willing to get help, call immediately for an appointment with a treatment counselor. Offer to go with the family member on the first visit to a treatment program and/or an Alcoholics Anonymous meeting.
  • Call a friend. If the family member still refuses to get help, ask a friend to talk with him or her using the steps just described. A friend who is a recovering alcoholic may be particularly persuasive, but any person who is caring and nonjudgmental may help. The intervention of more than one person, more than one time, is often necessary to coax an alcoholic to seek help.
  • Find strength in numbers. With the help of a health-care professional, some families join with other relatives and friends to confront an alcoholic as a group. This approach should only be tried under the guidance of a health-care professional experienced in group intervention.
  • Get support. It is important to remember that you are not alone. Support groups offered in most communities include Al-Anon, which holds regular meetings for spouses and other significant adults in an alcoholic's life, and Alateen, which is geared toward children of alcoholics. These groups help family members understand that they are not responsible for an alcoholic's drinking and that they need to take steps to take care of themselves, regardless of whether the alcoholic family member chooses to get help.

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.

Find a Treatment Program here.

Sources

  • National Institute of Mental Health
  • National Institute of Alcohol Abuse and Alcoholism
  • Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised
  • National Institutes of Health (NIH) - National Library of Medicine
Last reviewed 11/24/2014