Alcoholism (AL-ko-ha-li-zum) is a condition or progressive disease in which people crave alcohol and keep drinking it even though doing so causes repeated problems in many parts of their life.
Jennifer had her first glass of champagne at a family wedding when she was 11. By the time she was 13, she was drinking beer with her friends on Saturday nights. At 15, she was locking herself in her room and drinking alone during the week when she was supposed to be getting ready for school or doing her homework. At first, drinking seemed exciting. Before long, though, it became something she had to do just to get through the day. Jennifer was not old enough to get a driver's license, but she was already alcohol-dependent.
Alcoholism has little to do with what kind of alcohol people drink, how long they have been drinking, or even how much they drink. What is important is that the person cannot control the craving for alcohol, which explains why it is so hard for alcoholics to stop drinking. They may feel the need for alcohol as strongly as other people feel the need for food and water. Although some people are able to break the grip of this powerful craving on their own, most need help to do so.
Alcohol abuse refers to overuse of alcohol that can lead to alcoholism. Alcoholics recognize that they cannot drink any amount of alcohol and limit the amount they consume. If they begin drinking, they cannot stop. By contrast, alcohol abusers can limit their drinking, but they choose to drink to excess on certain occasions. Thus when they abuse alcohol, they can get into as serious trouble as any other drunk person can. The distinction between alcohol abuse and alcoholism is a matter of degree, both in behavior and dependence. Abusers of alcohol can experience loss of control and physical signs of tolerance, but if they choose to stop drinking, they do not experience painful withdrawal symptoms. Generally speaking, alcohol abuse is a less serious problem than alcoholism, but it still can have very serious consequences. Some symptoms of alcohol abuse are as follows:
Alcohol abuse can follow different patterns. Some people are binge drinkers, which means they drink only on certain days, such as on the weekend, and they drink to excess (five or more drinks at one time). Binge drinkers often have accidents that hurt themselves or others, or engage in activities while they are drunk that they regret later when they are sober. They are at risk of becoming heavy drinkers (five or more drinks at one time, occurring five or more days per month). Heavy drinkers in turn are at risk of becoming alcoholics because alcohol abusers are at high risk of developing alcoholism.
Alcohol dulls the senses, slows reaction time * , decreases coordination, and impairs judgment. It is little wonder that alcohol use is a major risk factor in homicides, suicide, accidents, and injuries. Death by injury is the leading cause of death among individuals from 15 to 20 years of age, and underage drinking is often involved. About two of every five traffic deaths in this age group involve alcohol. Individuals who begin drinking before the age of 15 are seven times more likely to be involved in an alcohol-related car accident in their lifetime, and they are five times more likely to develop alcoholism as an adult.
Alcohol robs people of their ability to think clearly. As a result, people are more likely to engage in risky sexual activity when they are drinking. Thus, they are at higher risk of unwanted pregnancy or sexually transmitted infections * . In addition, some boys believe that it is okay to force a girl to have sex if she is drunk. As a result, girls who drink are at greater risk of being raped * by someone they know. Alcohol is involved in many cases of date rape. Finally, the inability to think clearly causes people who are drinking to take dangerous risks, such as driving under the influence or engaging in daredevil stunts.
Alcoholism not only disrupts people's lives but also destroys their health. Long-term heavy drinking affects almost every organ in the body. The physical risks caused by alcoholism include the following:
Women get drunk more easily than men, even when differences in body weight are taken into account. The reason is that women's bodies contain less water per pound than men's bodies. Since alcohol mixes with body water, alcohol is closer to its undiluted strength in women than in men. Women appear more vulnerable than men to alcohol-related organ damage and trauma. Women also tend to have more legal and interpersonal problems associated with alcohol use.
Women who drink during pregnancy run the risk of having children with a wide range of physical, mental, and behavioral problems. Fetal alcohol syndrome (FAS) is the most severe set of birth defects caused by alcohol. FAS is a leading cause of intellectual disabilities in the world. Children with FAS may have problems with eating, sleeping, vision, and hearing. They may grow poorly and have birth defects of the heart, kidneys, skeleton, and other parts of the body. As children with FAS get older, they may have trouble following directions, learning to do simple skills, and paying attention in school. They may also find it hard to get along with others and control their behavior. Because no one knows exactly how much alcohol it takes to cause birth defects, it is best not to drink any alcohol at all during pregnancy.
Living with or caring about a person with alcoholism can be very stressful. This is especially true for the 11 million children under the age of 18 years in the United States who have an alcoholic parent. Alcohol use can lead to frequent arguments in the home, and it plays a role in the breakup of many marriages. In addition, alcohol use is a factor in more than half of all cases of family violence. It is not surprising that children of alcoholic parents are more likely to show signs of depression, anxiety, and low self-esteem than are other children. As they get older, they may have trouble in school, and they may tend to score lower on tests that measure verbal skills. They may also be more likely to have alcohol and drug problems of their own.
However, not all children of alcoholic parents are doomed to have problems with alcohol themselves. Many do well and thrive, particularly if they have positive relationships with other people, such as friends in school, teachers, or neighbors. Support groups for family members and friends, such as Al-Anon and Alateen, can also help people learn to cope with someone else's drinking.
Many young people first start drinking as a way to escape their problems, feel accepted, or feel better about themselves. Those who move on to frequent or heavy drinking are more likely to be depressed, have low self-esteem, or feel as if they do not fit in. Pressure from friends and easy access to alcohol may make it more likely that drinking will get out of control. Alcoholism also may tend to run in families, a pattern that may have psychological and genetic * causes. Children of alcoholic parents can be at risk for several reasons. They often live in stress-filled homes in which heavy drinking is commonplace. In addition, the genetic makeup of these children may increase their risk of alcoholism.
Warning signs include the following:
Complete abstinence from alcohol is the only treatment for alcohol dependence. Individuals may need to be hospitalized during alcohol withdrawal if they have a previous history of experiencing delirium tremens; if they have other serious health problems, including psychiatric conditions; and if they lack strong support systems. Treatment often begins with detoxification, the process of safely getting all the alcohol out of a person's body. During the first days after drinking is stopped, people may be given medication by a physician to replace the alcohol and then gradually be weaned off the medication. The goal is to reduce withdrawal symptoms and restore good health. Rest, a balanced diet, and plenty of fluids are also emphasized.
Once detoxification is complete, some people take medications to help prevent a return to drinking. Disulfiram (dy-SUL-fi-ram) can help deter alcohol use by causing several unpleasant symptoms when a person drinks alcohol, including severe nausea, vomiting, hot flushing, headache, and anxiety. Naltrexone (nat-TREK-zone) is another medication that is sometimes given to people with alcoholism. Scientists think it may block the craving for more alcohol that these people usually feel after taking a first alcoholic drink. Acamprosate may help combat alcohol cravings. Unlike disulfiram, naltrexone and acamprosate do not make the user feel sick after taking a drink.
Various kinds of therapies are used to treat alcoholism. Therapy can help people identify the feelings and situations that trigger their drinking. It can also help them find new ways to cope that do not involve using alcohol. Therapy can be provided individually or in a group, and it can take place in a mental health center, a hospital, or other setting. Social skills training teaches people to handle social situations without alcohol. There are several behavioral therapy approaches to treating alcohol addiction, including motivational incentives, community reinforcement, a system of rewards, and family therapy. Cognitive-behavioral therapy helps people learn to control harmful behavior and the impulse to drink. Family therapy focuses on problems among family members, which are made worse by alcohol consumption.
Most treatment programs include meetings of Alcoholics Anonymous or other self-help groups. People who take part in such groups get support from peers who face the same problems and are trying to solve them by applying positive steps. Some people may need to attend meetings daily at first. As recovery from alcohol dependence is a slow and very difficult process, the recovering individual may need to attend meetings for several years. Membership is open to anyone with a desire to stop drinking. Alcoholics Anonymous (AA) has more than 65,000 groups in the United States and Canada with over 1,400,000 members. AA is active in approximately 175 countries worldwide.
Alcoholism can be a tough addiction to beat, but treatment can be very helpful. Studies have shown that 7 out of 10 alcohol-dependent people who get treatment have stopped or cut back on their drinking and improved their health within six months, but relapse is common. The goal of treatment is for the alcoholic to quit drinking entirely and permanently, but most people have at least one or two relapses before they reach this goal. Medications may help people to regain control over alcohol. Slips are common, and they do not mean that people have failed. They just mean that people must stop drinking again and get whatever help they need to give up the habit. The longer people go without drinking, the more likely it is that they will stay sober permanently.
See also Addiction • Anxiety and Anxiety Disorders: Overview • Cancer: Overview • Cirrhosis of the Liver • Fetal Alcohol Spectrum Disorders (FASD) • Hallucination • Hangover • Heart Disease: Overview • Hypertension • Substance Abuse • Suicide
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* reaction time is the time it takes a muscle or some other living tissue to respond to a stimulus.
* sexually transmitted infection is an infection that can be passed from person to person by sexual contact.
* rape occurs when a person forces another person to have sexual intercourse, or engage in other unwanted sexual activities.
* stroke is a brain-damaging event usually caused by interference with blood flow to the brain.
* esophagus (eh-SAH-fuh-gus) is the soft tube that carries food from the throat to the stomach.
* larynx (LAIR-inks) is the voice box (which contains the vocal cords) and is located between the base of the tongue and the top of the windpipe.
* pancreas (PAN-kree-us) is a gland located behind the stomach that produces enzymes and hormones necessary for digestion and metabolism.
* colon (KO-lin), also called the large intestine, is a muscular tube through which food passes as it is digested, just before it moves into the rectum and out of the body through the anus.
* rectum is the final portion of the large intestine, connecting the colon to the outside opening of the anus.
* tremors is uncontrolled shaking, trembling, twitching, and/or quivering.
* delirium tremens (DTs) is seen in severe forms of withdrawal from alcohol. DTs includes tremors, confusion, agitation, hallucinations, disorientation, fear, and quick mood changes, among many other serious symptoms.
* genetic (juh-NEH-tik) refers to heredity and the ways in which genes control the development and maintenance of organisms.