Drinking alcohol is commonly used to celebrate, relax, or socialize with others. Our age, family history, how often we drink, and how much we drink are important variables to keep in mind when considering our relationship with alcohol. Drinking in moderation is a reasonable way to use alcohol. However, when we drink in excess, as a way to cope with or avoid other problems and stressors, it can lead to physical and emotional problems.
According to the U.S. Department of Health and Human Services and U.S. Department of Agriculture, Dietary Guidelines for Americans 2015–2020, moderate drinking is up to one drink per day for women and up to two drinks per day for men.
In the United States, one standard drink contains roughly 14 grams of pure alcohol, which is found in:
Because alcohol use varies greatly between people and over time, it can be helpful to think about signs that can signal the start of a problem, such as when drinking interferes with home life, school, or work. There may be a problem if you continue to drink even though it creates difficulties with family and friends. Or there may be a problem if you have to cut back activities because of drinking.
Alcohol abuse cuts across gender, race, and ethnicity. Nearly 14 million people—more men than women—in the United States are dependent on alcohol or have alcohol problems. Issues surrounding alcohol are highest among young adults ages 18 to 29 and lowest among adults ages 65 and older. Defining and diagnosing Alcohol Use Disorder can be complicated when working with young adults; the lifestyle of college students often includes excessive use of alcohol, making it difficult to ascertain when it is a problem and when it isn't.
Short-term effects include memory loss, hangovers, and blackouts. Long-term problems associated with heavy drinking include stomach ailments, heart problems, cancer, brain damage, memory loss, and liver cirrhosis. Heavy drinkers also markedly increase their chances of dying from automobile accidents, homicide, and suicide.
Alcohol use and abuse is also linked to a higher incidence of unemployment, domestic violence, and legal issues.
Alcohol Use Disorder is defined as a problematic pattern of drinking that results in two or more of the following situations within a 12-month period:
Alcoholism, or alcohol dependence, used to be considered the most severe form of alcohol abuse. The DSMV integrates alcohol abuse and alcohol dependence, into a single disorder called alcohol use disorder (AUD) with mild, moderate, and severe sub-classifications.
Mild: The presence of two to three symptoms
Moderate: The presence of four to five symptoms
Severe: The presence of six or more symptoms.
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 problem. A yes answer to more than one question indicates that a problem likely exists. Answering no to the above questions may still imply the need for help. It is important to consult a doctor or other health-care provider immediately and to be honest and forthcoming to determine if you have a drinking problem and, if so, to collaborate on the best course of action.
Health Hazards that may indicate problematic drinking habits or alcohol abuse:
The risk for developing alcoholism is influenced by both genetic and environmental factors.
Alcohol abuse tends to run in families: The rate of the condition is three to four times higher in close relatives of alcoholics, and the risk increases according to the closeness of the genetic relationship.
Environmental factors include cultural attitudes about drinking, availability of alcohol, stress levels, substance abuse by peers, positive expectations about the use of alcohol, and maladaptive ways of coping. Impulsivity as a personality variable is also linked to high alcohol use and abuse.
The risk for abusing alcohol also increases if individuals use drinking to avoid thinking about things, to numb themselves to their problems, to cope with anxiety, fears, or mood issues, or to enhance their creativity.
Many people with alcohol problems don't recognize that their drinking has become problematic, and others are not ready to get help with their drinking. It is important for each individual to consider the pros and cons related to drinking and to decide whether cutting down (harm reduction) or quitting altogether (abstinence) is necessary.
Abstinence from alcohol is strongly recommended for those who
Others may benefit from the harm-reduction approach, aimed to help individuals reduce the impact of the consequences associated with drinking.
When drinking is associated with problematic behavior caused by significant intoxication and/or with withdrawal symptoms (nausea, vomiting, agitation, insomnia, seizures, and/or hand tremors), detoxification may be required to start the process of treatment.
Detoxification, entailing 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, such as delirium tremens (DT's), which could be fatal, may occur. Depression or other underlying mood disorders should be evaluated and treated as alcohol abuse often develops from efforts to self-treat an illness.
Following detoxification, alcohol recovery or rehabilitation programs support the affected person 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 person residing in the facility during the treatment, or outpatient, with the individual attending the program while living at home.
It is also important to remember that other psychiatric conditions, such as depression or bipolar disorder, may coexist with alcoholism. Therefore, coexisting or underlying disorders may also need to be treated. Individuals suffering from such conditions may have used alcohol as a form of self-medication. If this is the case, dual diagnosis of any coexisting condition is essential for guiding treatment.
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 the craving for alcohol in those who have stopped drinking. Acamprosate is thought to work by reducing the symptoms, such as anxiety and insomnia, that may follow lengthy abstinence. Disulfiram discourages drinking by making individuals feel sick if they drink alcohol.
Other types of drugs are available to help manage the symptoms of withdrawal, such as shakiness, nausea, and sweating, that may occur after someone with alcohol dependence stops drinking. Early recognition of these symptoms and immediate treatment can prevent some of them or drastically limit their severity.
Virtually all alcoholism treatment programs also include support groups such as Alcoholics Anonymous (AA). 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 the meetings work 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 a medical emergency. Many alcoholism treatment specialists suggest the following steps to help an alcoholic:
Alcoholism treatment works for many people. But as with 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.
Last reviewed 05/08/2017