Alcoholism is a chronic (long-term) disease in which people become physically dependent on alcohol and cannot control how much they drink even though their drinking is damaging their health, schoolwork or job performance, and friendships or family relationships. It is a progressive disease, which means that without treatment, it gets worse over time.
Some doctors use the term “alcohol abuse” to describe heavy drinking that causes problems in the person's life but has not yet led to physical dependence on alcohol or complete loss of control over drinking.
Binge drinking refers to consuming a number of drinks in a row on a single occasion, usually five drinks for men and four for women. A drink is defined as one 12-ounce beer, one 4- to 5-ounce glass of wine, or one mixed drink containing 1.5 ounces of whiskey or other liquors. Some binge drinkers may claim that they do not have a problem with alcohol because they do not drink every night.
Alcoholism is a serious disease not only for the damage it does to the health and lives of alcoholics but also to the burden it places on society as a whole. It is the third leading cause of preventable death in the United States, after smoking and obesity. Alcoholism is responsible for 85,000 deaths in the United States each year. About one in every twelve adults in the United States—17.6 million people—abuse alcohol or are dependent on it.
Around the world, alcoholism is responsible for a percentage of various disease conditions:
- Cirrhosis of the liver: 32 percent
- Motor vehicle crashes: 20 percent
- Cancer of the esophagus: 29 percent
- Liver cancer: 25 percent
- Stroke: 10 percent
- Homicide: 24 percent
- Suicide: 11 percent
Women who drink during pregnancy are at risk of having children who are mentally retarded and underweight at birth. This condition,
known as fetal alcohol syndrome or FAS, affects one or two of every 1,000 babies born in the United States each year.
Two Screeners for Alcoholism
Two brief screening tests that doctors often use to evaluate a patient's dependence on alcohol are called the CAGE and Alcohol Use Disorders Identification Test (AUDIT) questionnaires. The CAGE questions are usually asked face to face in the doctor's office, but the AUDIT can be filled out with paper and pencil.
The CAGE questions:
- Have you ever felt the need to cut down on your drinking?
- Do people annoy you by criticizing your drinking?
- Have you ever felt guilty about your drinking?
- Do you ever need an eye-opener in the morning after a night of drinking?
The AUDIT questionnaire has ten questions:
- How often do you have a drink?
- How many drinks do you have on a typical day when you have a drink?
- How often do you have six or more drinks on a single occasion?
- How often during the past year have you found that you couldn't stop drinking?
- How often during the past year have you failed to do something you should have done because of drinking?
- How often during the past year have you needed a drink first thing in the morning?
- How often during the past year have you felt sad or guilty after drinking?
- How often during the past year have you been unable to remember what happened after drinking?
- Have you injured yourself or anyone else as a result of drinking?
- Has a friend, relative, or doctor expressed concern about your drinking?
There is no single way that people become alcoholics. One reason why the experience of the disease is so difficult to describe is that the speed at which it develops and its consequences vary from person to person. Some people say that they became alcoholics after their first few drinks. Others drank responsibly for years and then became dependent on alcohol in midlife or even old age. In addition, some people get help before they get into serious trouble from drinking. They are sometimes called “high-bottom” alcoholics—that is, they “hit bottom” with their drinking while they still have a job or family. Alcoholics who have found themselves in trouble with the law, are homeless, or have lost their jobs and families sometimes refer to themselves as “low-bottom” alcoholics.
According to a study of adults in the United States conducted by the National Longitudinal Alcohol Epidemiologic Study, 44 percent of American adults are social drinkers; 22 percent drank at one time but do not drink alcohol at present; and 34 percent have always abstained from alcohol. Between 8 and 10 percent of adults are diagnosed with alcohol abuse or dependency in an average year.
Risk factors for alcoholism include:
- Genetics. Although no specific genes have been identified as causes of alcoholism, a study done in 2006 estimated that genetic factors account for 50 to 60 percent of a person's vulnerability to alcohol abuse.
- Family history of alcoholism.
- The age at which a person started to drink. People who began to drink before age sixteen are at higher risk of alcohol abuse.
- Gender. Men are two to three times more likely to become alcoholics than women. Women, however, do not metabolize alcohol as efficiently as men and can become intoxicated on smaller amounts of alcohol than men of the same weight.
- Race and ethnicity. Native Americans are at increased risk of alcohol abuse, followed by Hispanics, Caucasians, African Americans, and Asian Americans.
- A history of depression or other mental disorders.
Alcoholism is the end result of a combination of factors that interact in ways that are unique to each person with the disorder:
- Genetic factors. These are thought to account for at least half of the cases.
- Psychological and emotional stress. Some people turn to alcohol to cope with anxiety, depression, posttraumatic stress disorder, or other painful feelings. This misuse of alcohol is called self-medication.
- Social and cultural factors. People may begin to drink heavily to look grownup or because their friends are encouraging them to drink. In some groups, heavy drinking may be seen as proof of masculinity. In addition, many films and television shows make drinking look glamorous or sophisticated.
- Body chemistry. Long-term drinking alters the levels of various chemicals in the brain, leading the person to crave alcohol either to get rid of bad feelings or to restore good feelings. Some people find that they eventually need alcohol just to feel normal.
The main symptom of alcoholism is denial; that is, alcoholics deny that they have a drinking problem until a series of health problems, family arguments, job losses, arrests, or other negative consequences force them to admit their drinking is out of control. Other symptoms commonly include:
- Drinking alone or in private.
- Hiding alcohol in the car, office, or other secret places.
- Feeling irritated or angry if unable to have a drink at the usual time.
- Gulping drinks quickly or drinking just to feel normal.
- Having problems with employment, finances, or the law.
- Building up tolerance to alcohol; that is, needing larger amounts to get the same effects.
- Having withdrawal symptoms after going without alcohol for a few days. These symptoms include shaking, insomnia, nausea, and vomiting.
- Feeling a need or compulsion to drink.
- Having blackouts. A blackout describes when someone is unable to remember what happened while he or she was drinking but did not pass out.
The diagnosis of alcoholism is usually made on the basis of the patient's history and a review of his or her answers to screening questionnaires. The two screeners most often used are called the CAGE and AUDIT questionnaires (see sidebar). They can be completed in the doctor's office. People who answer yes to two of the four CAGE questions are seven times more likely to have a drinking problem than people in the general population. The AUDIT questionnaire assigns points ranging from zero to four depending on the frequency of the behaviors mentioned in the questions. A score of eight or higher indicates a high likelihood of alcoholism.
Although there are blood and urine tests that can detect the presence of alcohol or its breakdown products in the body, these tests reflect only whether the person was drinking at the time the test was given. Such tests are not useful in detecting long-term drinking patterns.
In general, doctors often miss the diagnosis of alcoholism in their patients. This occurs because of the patient's denial or the patient's fear that the doctor will tell his or her employer or other family members.
Treatment of alcoholism is important not only for the disease itself but also as a necessary first step toward treating other disorders. For example, psychiatrists will not treat someone for a mental disorder like bipolar disorder or depression as long as the person is still drinking. Patients with liver disease and other physical problems related to drinking also need to be treated for alcoholism before their physical health will improve.
Treatment of alcoholism usually proceeds in several stages.
- Intervention. Intervention is the term used for persuading the alcoholic to get help. It may be done by family members, the person's employer, a doctor, or others concerned about the person. The reason that intervention is usually necessary is that only 15 percent of alcoholics seek help on their own.
- Detoxification. Sometimes nicknamed detox, this is a process that takes between four and seven days. The alcoholic is placed in a treatment center where he or she is given medications (usually tranquilizers) to control the symptoms of withdrawal from alcohol. These symptoms may include sweating, nausea, vomiting, seizures, or a severe reaction called delirium tremens (also called the DTs). In delirium tremens, the person may hallucinate and have very high blood pressure and rapid breathing. It can be fatal if not treated.
- Rehabilitation. Rehabilitation for alcoholics includes patient education about the effects of alcohol, support groups, psychological counseling, and an emphasis on getting the patient to accept the truth about his or her alcohol dependence.
- Medications. There are several drugs, the best-known of which are Antabuse and Campral, which work either by making the person feel sick if he or she drinks or by lowering the craving for alcohol. These drugs work best in highly motivated patients. However, they are not magic cures for alcoholism.
Most doctors think that alcoholics should completely give up drinking because of the danger of relapse (falling back into out-of-control drinking). Although a few people who are not physically dependent on alcohol but have found themselves in trouble for abusing it can
sometimes manage by simply cutting back on the amount they drink, complete abstinence is the best option for recovery.
There is no cure for alcoholism. Recovery requires lifelong commitment to abstaining from alcohol and being honest with oneself. The prognosis is better for alcoholics who do not smoke and are not addicted to other drugs. Nonetheless, only about 30 percent of alcoholics maintain their recovery over the long term. Studies have shown that about half of those who complete a detoxification program relapse within six to twelve months.
People who have a family history of alcoholism can lower their risk of becoming alcoholics by learning about alcoholism and building a strong social support network. Parents can help by setting an example of responsible use of alcohol and talking openly about the physical and mental dangers of heavy drinking.
According to statistics kept by the National Institutes of Health (NIH), the rate of alcoholism and alcohol abuse is rising in the United States and other developed countries. Some of the reasons for this trend are the easy availability of alcohol (including homemade alcoholic beverages); the role of the mass media in promoting drinking; and the weakening of family ties.
SEE ALSO Child abuse; Fetal alcohol syndrome; Smoking; Stroke
WORDS TO KNOW
Abstinence: Complete stopping of alcohol consumption.
Blackout: Alcohol-related memory loss.
Delirium tremens: A severe physical reaction to withdrawal from alcohol in which the person hallucinates and has unstable blood pressure and breathing patterns.
Detoxification: A process or treatment program for clearing an alcoholic's body of alcohol. It usually includes medications to help manage the physical symptoms of withdrawal.
Relapse: Returning to uncontrolled drinking.
Tolerance: The need for greater and greater amounts of a drug to get the desired effects.
Withdrawal: A group of physical and emotional symptoms associated with stopping the consumption of alcohol after long-term heavy use.
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