Alcohol and drug abuse

What is alcoholism?

Alcoholism is a chronic, often progressive illness that affects nearly 1 in every 13 adults. Even more people engage in dangerous drinking patterns such as binge drinking that could eventually lead to alcoholism and other alcohol-related problems. Approximately 53 percent of adults in the United States report that one or more of their close relatives has a drinking problem. Alcoholism affects people of all ages, regardless of gender, education, socioeconomic status, or ethnicity.¹

Although drinking in moderation is typically defined by experts as an average of one to two drinks per day for men and one drink per day for women, there is no magic cutoff number that indicates how many drinks a person must have before he or she may be called an alcoholic. Nor is there any golden rule that dictates how often a person must drink before he or she is considered alcoholic. Alcoholism is defined by the fact a person has become psychologically and emotionally dependent on alcohol in everyday life. On a physical level, an alcoholic's body has come to depend on alcohol to perform normal chemical reactions, including those in the brain. Physical dependence means that if alcohol use is suddenly stopped, the body's environment changes radically, causing withdrawal symptoms such as tremors, rapid pulse, rapid breathing, insomnia, fever, hallucinations and seizures.²

Alcoholism is typically characterized by:

• craving—a strong need or compulsion to drink
• loss of control and the inability to stop drinking once drinking has begun
• physical dependence as evidenced through physical withdrawal symptoms such as nausea, sweating, shakiness and anxiety when alcohol is stopped. Withdrawal symptoms are usually relieved by drinking alcohol or through the use of other sedative drugs.
• tolerance—the need for increasing amounts of alcohol in order to get high

Alcoholism is a disease and alcoholics continue to drink, despite family, health or legal problems. When a person is alcoholic, quitting drinking is not as simple as simply exercising will power. For alcoholics, the craving for alcohol can be as strong as the craving for food or water. The craving for alcohol overrides the ability to stop drinking.

How does alcohol abuse differ from alcoholism?

Alcohol abuse is characterized by a pattern of continuous and heavy alcohol use. Those who abuse alcohol continue to drink even though drinking causes significant problems in their lives. They may become intoxicated on weekends or go on drinking binges between periods of abstaining from alcohol. They may have domestic problems, neglect parenting responsibilities, and engage in frequent arguments about drinking. They may experience increased problems at work—hangovers may result in absenteeism, for example, or they may operate machinery while under the influence of alcohol. They may experience problems with the law, being arrested for disorderly conduct or for driving while drunk.

Unlike alcoholism, alcohol abuse isn't characterized by an extremely strong craving for alcohol, lack of control, and physical dependence. Alcohol abuse is characterized by a pattern of drinking that results in one or more of the above situations within a 12-month period. Alcohol abuse can develop into alcohol dependence and alcoholism.⁴

What are the risks of alcohol abuse and alcoholism?

Alcoholism carries with it a long list of psychological, interpersonal, social, economic and medical problems. Alcoholism is often linked to depression and suicide. It has been known to play a role in violent crimes such as homicide, as well as in cases of domestic violence or child abuse. Intoxicated pedestrians choosing to walk home after drinking and people driving while under the influence of alcohol has given rise to increased traffic accidents and traffic fatalities. Engaging in high-risk sexual activity while intoxicated can result in unplanned pregnancy and sexually transmitted diseases, including HIV/AIDS. Alcohol dependence increases the risk of liver diseases such as hepatitis and cirrhosis, stomach ulcers, brain damage, and stroke. Pregnant women who drink place their unborn child at risk for Fetal Alcohol Spectrum Disorder.⁵

What are the signs of alcoholism?
How can I tell if someone I know is an alcoholic?

In determining whether someone has an alcohol problem, the NIAA (National Institute on Alcohol Abuse and Alcoholism) suggests looking for the following behaviors:⁶

Needing a morning "eye-opener" drink to steady your nerves or to fight a hangover Worrying that you might be drinking too much Feeling guilty about drinking Feeling annoyed because other people have criticized your drinking Having long episodes of intoxication Drinking alone Having blackouts Driving drunk

Having work problems or financial problems caused by drinking Losing interest in food Being careless about your personal appearance Hurting yourself or someone else while you are intoxicated Hiding liquor bottles and glasses so that other people won't know that you've been drinking Experiencing mood or personality changes

Because excess alcohol can be toxic to the body's internal organs, alcoholism may result in the following physical symptoms:⁷

Signs of malnutrition due to a poor diet Abdominal pain or diarrhea A flushed red color to the face and palms Morning nausea or shaking

Numbness, weakness or tingling in the arms or legs Unusually frequent accidental injuries, especially falls

What causes alcoholism? Who's at special risk?

In most Western countries, the chance of developing alcoholism is approximately 10 percent for men and between 3 and 5 percent for women. Although there is evidence to suggest that heredity and genetics are responsible for part of a person's risk for alcoholism, not everyone with a family history of alcoholism will become an alcoholic. Other factors such as availability of alcohol, severe personal problems, and peer influences are often more important than heredity in determining whether certain people will become alcoholics.⁸

Genetics play a significant role in determining an individual's risk for alcoholism and may account for about fifty percent of a person's total risk for alcoholism. Alcoholism is so complex, however, that it's unlikely one single gene can be singled out as the major cause. Currently, researchers are investigating a number of inherited traits that predispose certain people to alcoholism. These include:⁹

• A smaller amygdala (an area of the brain believed to play a role in the emotional aspects of craving) in subjects with a family history of alcoholism. A smaller amygdala is thought to lead to addiction.
• Lack of genetic protection to protect against excessive consumption. Lack of "signals" that ordinarily make people stop drinking is believed to contribute to between 40% and 60% of alcoholism cases related to genetic factors.
• When alcohol is metabolized, it is first converted to acetaldehyde (AcH), which is then converted to acetate. It's thought that because Jewish people and people of Asian descent have a genetic deficiency in AcH, they are less likely to become alcoholic.
• Dysfunction in the transmission of serotonin is associated with high levels of tolerance for alcohol, as well as with impulsive and aggressive behaviors. This can predispose people to drink and increase the risk for dangerous behaviors and suicide in alcoholics.

How is alcoholism diagnosed?

Admitting you have a problem and seeking help may not be easy, but remember that the sooner you ask for help, the better your chances for a successful recovery.

Your doctor will diagnose alcoholism based on a physical examination and your medical history. During the physical exam, your doctor will check for signs of poor nutrition and alcohol-related liver or nerve damage. You will likely be asked about your history of using alcohol, about any alcohol-related problems you may have had at home or at work, and about any arrests or instance of driving while impaired. You may be asked whether you've experienced any symptoms of alcoholism.¹⁰

Your doctor may also recommend additional blood tests to check for anemia, vitamin deficiencies, and abnormal levels of liver chemicals such as acetaldehyde and acetate. Blood tests will also help your doctor determine your blood alcohol level and any damage caused to your body by alcohol. Blood and urine tests are also used to rule out other medical conditions. In some cases, your doctor may recommend a mental health assessment to determine whether you are suffering from conditions such as depression or social anxiety disorder. These conditions often coincide with alcoholism and alcohol abuse.¹¹

How is alcoholism treated?

Although there is no way to prevent or to cure alcoholism, treatment is available. The key to recovery from alcoholism is to stop drinking permanently.

The first step in the recovery process is detoxification—immediate withdrawal from alcohol. Detoxification may take place in an outpatient clinic. In more severe cases, a person may need to be admitted to a hospital or to a drug treatment facility. For the first few days, you will experience withdrawal symptoms. Your doctor will likely prescribe tranquilizers known as benzodiazepines to lessen the effects of your withdrawal symptoms. Following this, you may be prescribed naltrexone or disulfiram, medications designed to lessen your craving for alcohol and to help prevent a return to drinking once drinking has stopped.¹²

After detoxification, most alcoholics need long-term support and counseling in order to remain sober. Counseling helps teach alcoholics to identify situations and feelings that may compell them to drink. Counseling teaches ways to modify behavior and to find new ways to cope with stresses of everyday life which do not involve alcohol.

The support of family members is important during the recovery process and for this reason, many recovery and treatment programs include family and marital counseling in their approach. Treatment programs may also include links to community resources such as child care, job training, legal aid, and parenting classes.¹³

Although not everyone responds to the approach taken by Alcoholics Anonymous, many alcoholics do benefit from AA, a "worldwide fellowship of men and women who help each other to stay sober." For those who don't respond to AA's style or message, other recovery approaches are available.¹⁴

Treatment may help alcoholics regain health and although they may remain sober for a long time, they are never cured of alcoholism—they still remain susceptible to relapse and must avoid alcohol. Despite a person's determination to stay sober, relapses do happen before a person reaches long-term sobriety. If you do suffer a relapse, you're not alone, and you shouldn't berate yourself. Relapses are very common and they should never be taken to mean that a person has failed in their treatment or that they cannot ever recover from alcoholism. If you do have a "slip," stop drinking and be sure to get the additional support you need.¹⁵

1. Alcoholism

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   — Getting the Facts. National Institute on Alcohol Abuse and Alcoholism (NIAAA)
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14. Alcoholism — Getting the Facts. National Institute on Alcohol Abuse and Alcoholism (NIAAA)
15. Alcoholism — Getting the Facts. National Institute on Alcohol Abuse and Alcoholism (NIAAA)