Alcohol Abuse and Alcoholism: Signs, Effects and Treatment
Alcohol problems are now called Alcohol Use Disorders, and
include both abuse and dependence. The problems associated with
alcohol use are well known. Alcohol is associated with auto
accidents, increased violence, loss of jobs, and loss of lives.
What makes it possible for most people to have a couple of
glasses of wine, beer or hard liquor at a party and stop, while
others go on to have serious problems with alcohol?
What are the signs and symptoms of alcohol abuse? Alcohol abuse
is a pattern otherwise known as "problem drinking." The
behavioral warning signs of alcohol abuse are:
Drinking excessive amounts of alcohol frequently (The National
Institute on Alcohol Abuse and Alcoholism has established two
drinks per day for men and one drink a day for women as the
limits to safe drinking) Drinking when it is dangerous (such as
driving) Frequent excessive drinking (known as binge drinking)
Interpersonal difficulties with family, friends, or co-workers
Legal problems related to drinking. Alcohol abuse may initially
be diagnosed in young people who recently began drinking.
However, they may also be involved with other drugs, without
alcohol being the primary substance they are using. Although
some alcohol users abuse alcohol without becoming
alcohol-dependent alcoholics, over time abuse may progress to
incurable alcoholism.
What is alcoholism (compared to alcohol abuse)? Alcoholism, also
known as alcohol dependence, differs from the alcohol abuse
pattern in three critical ways. It is:
chronic progressive, and potentially fatal. The symptoms of
alcoholism include those of alcohol abuse plus four serious
additional symptoms:
Craving--A strong need, or urge, to drink Loss of control--Not
being able to stop drinking once drinking has begun Physical
dependence--Withdrawal symptoms, such as nausea, sweating,
shakiness, and anxiety after stopping drinking Tolerance--The
need to drink greater amounts of alcohol to get "high." What are
the effects of alcoholism? Alcoholism is a disease that lasts an
addict's lifetime. The consequences of alcoholism are serious.
Heavy drinking can cause:
increased risk of cancers of the liver, esophagus, throat, and
larynx liver cirrhosis immune system problems brain damage harm
to the fetus during pregnancy (Fetal Alcohol Syndrome) that may
impact the child's brain, resulting in learning and behavior
problems male and female incontinence (usually related to
cirrhosis) loss of erectile function, leading to impotence
Denial is an alcoholic's strongest defense mechanism. But even
if the alcoholic is quite aware of these serious implications of
heavy drinking, the craving that an alcoholic feels for alcohol
can be as strong as the need for food or water. An alcoholic
will continue to drink despite serious family, health, or legal
problems.
People who do not drink or who are alcohol abusers but not
alcoholics sometimes do not understand why an alcoholic can't
just "exercise a little willpower" to stop drinking. However,
alcoholism is an addiction that little to do with willpower. Any
addiction has both physical and psychological components that
make it extremely difficult to break. Almost all alcoholics need
the aid of external treatment to help them succeed in overcoming
their addiction.
What causes alcoholism? People drink in many social situations,
but also use alcohol as a means to "self-medicate" other
problems, such as stress, anxiety, depression, or mental
illnesses. No one who takes a drink thinks he or she will become
an alcoholic. While it is not possible to predict whose drinking
will lead to alcoholism, there is growing evidence of certain
causal factors. The most recent scientific research points to
two main areas:
Genetics. Studies conducted among twins and children of
alcoholics have shown that genetic factors influence alcoholism
and that children of alcoholics are about four times more likely
than the general population to develop alcohol problems.
Currently, researchers are working to discover the actual genes
that put people at risk for alcoholism. Another branch of
investigation is into whether there is a specific area of the
brain that is different in alcoholics, and whether genetics may
also be a factor in this. Lifestyle. Just because alcoholism
tends to run in families does not mean that a child of an
alcoholic parent will automatically become an alcoholic, too.
While genes partially explain this pattern, more than one-half
of all children of alcoholics do not become alcoholic. The risk
is higher but other factors may increase the risk for
alcoholism:
friends and social activities the amount of stress in one's life
how readily alcohol is available role-models (family, friends,
or media heroes) who drink What should you do if you suspect
alcohol abuse or alcoholism? The biggest obstacle to treatment
of alcoholism is getting the alcoholic to break through the
denial that is a hallmark of this condition, to realize that
help is needed. The National Institute on Alcohol Abuse and
Alcoholism suggests that you ask the following four questions
that can help you find out if you or a loved one has a drinking
problem:
Have you ever felt you should cut down on your drinking? Have
people annoyed you by criticizing your drinking? Have you ever
felt bad or guilty about your drinking? Have you ever had a
drink first thing in the morning to steady your nerves or to get
rid of a hangover? More than one "yes" answer means it is highly
likely that a problem exists. If you think that you or someone
you know might have an alcohol problem, it is important to see a
doctor or other health care provider right away. They can help
you determine if a drinking problem exists and plan the best
course of action. Among the steps that can be taken are:
Discuss the benefits of stopping your drinking pattern Set a
drinking goal, either abstinence or a limited amount Examine the
social or pressure situations that trigger your drinking Develop
new ways to handle trigger situations so you can maintain your
goal Attend Alcoholics Anonymous meetings for support Consider
Moderation Management (MM), a behavioral change program and
national support group network for people who are not alcoholics
but who have made the decision to reduce their alcohol
consumption. This program is based on the premise that alcohol
abuse is a learned behavior (as contrasted with alcohol
dependence, which is a disease). For those who are not
alcoholics but recognize the need to reduce their alcohol use,
MM provides: a program for problem drinkers that is not
abstinence-based a mutual-help environment to help people cut
back on drinking before it becomes a dependency issue
empowerment to take personal responsibility for deciding if
moderation or abstinence would be a better individual choice
information about alcohol and moderate drinking guidelines and
limits drink monitoring exercises goal setting techniques
self-management strategies If a friend is diagnosed as being an
alcoholic but is unwilling to get help, you can't force him or
her to do so. However, many alcoholism treatment specialists
suggest the following steps to help convince an alcoholic to get
treatment:
Stop all cover ups and other "enabling" behaviors (don't try to
protect the alcoholic from the results of his or her drinking)
Time your intervention (the best time to talk to the drinker is
shortly after an alcohol-related incident has occurred) Be
specific (use examples like the most recent incident to show how
his or her drinking has caused problems) Explain to the drinker
what you will do if he or she doesn't seek help (do not make any
threats you are not prepared to carry out) Gather information
about local treatment options (if the alcoholic is willing to
get help, call immediately for an appointment with a treatment
counselor) How is alcoholism treated? There is no "one size fits
all" treatment for alcoholism. Instead, there are many different
treatments that depend on the needs of the individual and the
severity of the abuse. Treatments might include:
therapy to help individuals understand their behavior and
motivation and improve coping skills medication to relieve
withdrawal symptoms and control cravings self-help and support
groups. Treatment can be provided in a variety of settings:
medical facility residential setting (round-the-clock or
half-way "sober living"house) outpatient Therapy
The three most commonly used behavioral treatments for
alcoholism are:
motivation enhancement therapy cognitive-behavioral therapy, and
12-step facilitation therapy These treatment options have proven
to be effective in reducing alcohol problems and fostering
abstinence. One large-scale study found that each of these
treatment modalities significantly reduced drinking in the year
following treatment. The study also found that about one-third
of the study participants who were followed up either were still
abstinent or were drinking without serious problems three years
after the study ended.
Self-Help Programs
There are a number of self-help programs that help the alcoholic
deal with the disease.
Alcoholics Anonymous (AA) is the largest self-help organization:
founded by alcoholics group meetings facilitated by members
meetings take place on a regular basis daily, at various times,
and in many different locations around the world attendance is
voluntary, and membership is free members are free to attend any
of the many meetings held each week includes support from fellow
members who either are struggling or have struggled with the
same problem uses a buddy system ("sponsor") and group
intervention to help members when they are tempted to relapse or
do relapse uses the 12-Step Program as guiding principles
(developed by the earliest members of Alcoholics Anonymous;
adopted and adapted to many other self-help programs)
abstinence-based personal recovery program from the substance or
addictive behavior person admits his or her powerlessness over
the substance or behavior turns his or her fate over to a higher
power "as you understand it" follows steps to examine the
effects the behavior has had on his or her life, to accept
responsibility for damage caused to others, and to make amends
There are also several non-12-Step programs available, for those
who have other interests, special needs, or who object to the
"higher power" or "powerlessness" basis of AA:
Secular Organizations for Sobriety (SOS)
a network of independent meetings with an alternative recovery
method promotes abstinence and provides support from others
struggling with the same issues encourages self-empowerment
approaches to recovery for those who are uncomfortable with the
spiritual content of AA takes the approach that sobriety is a
separate issue from religion or spirituality credits the
individual for achieving and maintaining his or her own
sobriety, without reliance on any Higher Power SMART Recovery
(Self Management And Recovery Training)
aims toward abstinence, with focus on self-empowerment,
self-reliance, and self-directed change based on principles of
Cognitive-Behavioral Therapy (CBT) teaches specific tools and
techniques within a 4-point program Enhancing and Maintaining
Motivation to Abstain Coping with Urges Problem Solving
(Managing thoughts, feelings and behaviors) Lifestyle Balance
(Balancing momentary and enduring satisfactions) Women for
Sobriety (WFS)
Founded in 1976, this is the only national organization focusing
specifically on the needs of alcoholic women, whose recovery in
AA was found to be less successful than for men. Premises and
structure are:
the psychological needs are different for women than for men
weekly meetings in small groups of 6-10 women, with a structured
format for confidential discussion based on thirteen positive
statements to encourage emotional and spiritual growth, with
emphasis on: positive reinforcement (approval and
encouragement). cognitive strategies (positive thinking).
letting the body help (relaxation techniques, meditation, diet
and physical exercise). Outpatient Treatment
Outpatient treatment refers to treatment that does not require
overnight stays in the facility. Treatment can include drug
education, individual and group counseling, education groups for
caregivers, and case management services. Outpatient treatment
varies in the types and intensity of services offered. For
example:
night classes allows a person to maintain a job requires more
personal self-management intensive outpatient day programs in
hospitals for adults who requires continuity of treatment
becoming a common treatment option typically 8-hour treatment
sessions, including group therapy with emphasis on preventing
relapse, managing stress, and communicating with family.