Alcohol Dependence and Abuse

Alcohol dependence and abuse (what the public typically thinks of as alcoholism) fall into three categories.

People in the latter two categories described often resist seeking help because the control they exercise over their intake (aside from binges) allows them to maintain a normal daily schedule and function well at work or at school. They do not see their drinking as a problem.

The cause of alcohol dependency is difficult to pinpoint, but it likely involves a combination of heredity, self image, and other psychological factors and life experiences (e.g., marriage, career, and money problems). Regardless of the cause, it remains a major health issue. According to the National Institute on Alcohol Abuse and Alcoholism, 24.6% of people ages 18 or older reported that they engaged in binge drinking and 6.8% reported that they engaged in heavy drinking in the month prior to a 2013 survey. The institute also noted that 7.0% of American adults (16.6 million) had an alcohol use disorder in 2013, including 9.4% of adult men and 4.7%of adult women. (An alcohol use disorder is defined as alcohol abuse and alcohol dependence.) Among youths aged 12–17 years, 2.8% had an alcohol use disorder, including 3.2% of females and 2.5% of males in this age group.

A key physiological component of alcohol dependence is what is referred to as neurological adaptation, or more commonly as tolerance, whereby the brain adapts itself to the level of alcohol contained in the body and in the bloodstream. This process occurs over time as individuals continue to drink regularly, while increasing the amount consumed in order to achieve the desired effect. Research has shown that some individuals appear to have an inherited trait—a genetic component—that makes them less susceptible to alcohol's effects. Due to this heightened tolerance, these people may consume more alcohol than those who do not have that trait and ultimately be more likely to become alcohol-dependent.

Studies of offspring of alcoholics show that they are more likely than other children to experience certain problems in childhood and/or adolescence. These problems include:

Alcohol abuse has many consequences. One notable concern is fetal alcohol syndrome, which affects children born to women who drink during pregnancy. In the United States, fetal alcohol syndrome affects 5,000– 12,000 newborn babies each year. Symptoms include mental retardation, delayed development (including language skills), slowed growth, certain characteristic facial features (e.g., drooping eyelids and flattened cheeks), hyperactivity, and learning and memory problems.

Alcohol also has a negative effect on human organs, especially the liver, and a lifetime of drinking can cause terminal illnesses of the liver, stomach, and brain. It can also increase the risk of developing breast, liver, esophagus, throat, and other cancers. In addition, drunk driving is a serious problem in the United States. According to the NIAAA, nearly 31% of driving fatalities in the United States each year involve alcohol-impaired driving.

Therapists and the medical community frequently use the CAGE test as a first step to evaluate alcohol dependence and/or abuse. This simple, four-question test, developed by John Ewing, founding director of the Bowles Center for Alcohol Studies at the University of North Carolina at Chapel Hill, takes its name from a key word in each question:

One yes answer to the CAGE test suggests a possible alcohol problem.

See also Addiction/Addictive personality .