Alcoholism
Definition
Alcoholism is drinking alcoholic beverages at a level that interferes with physical health, mental health, and social, family, or job responsibilities.
Causes
Alcoholism is a type of drug addiction. There is both physical and mental dependence on alcohol.
Alcoholism is divided into 2 categories: dependence and abuse. People who are dependent on alcohol spend a great deal of time drinking alcohol, and getting it.
Physical dependence involves:
- A need for increasing amounts of alcohol to get drunk or achieve the desired effect (tolerance)
- Alcohol-related illnesses
- Memory lapses (blackouts) after drinking episodes
- Withdrawal symptoms when alcohol use is stopped
The most severe drinking behavior includes long drinking binges that lead to mental or physical problems. Some people are able to gain control over their dependence in earlier phases before they totally lose control. But no one knows which heavy drinkers will be able to regain control and which will not.
There is no known common cause of alcoholism. However, several factors may play a role in its development. A person who has an alcoholic parent is more likely to become an alcoholic than a person without alcoholism in the immediate family.
Research suggests that certain genes may increase the risk of alcoholism, but which genes or how they work is not known.
Psychological factors may include:
- A need for anxiety relief
- Conflict in relationships
- Depression
- Low self-esteem
Social factors include:
- Ease of getting alcohol
- Peer pressure
- Social acceptance of alcohol use
- Stressful lifestyle
The incidence of alcohol intake and related problems is rising. Data indicate that about 15% of people in the United States are problem drinkers, and about 5% to 10% of male drinkers and 3% to 5% of female drinkers could be diagnosed as alcohol dependent.
Symptoms
Alcohol affects the central nervous system as a depressant. This leads to a decrease in:
- Activity
- Anxiety
- Inhibitions
- Tension
Even a few drinks can change behavior, slow motor skills, and decrease the ability to think clearly. Alcohol can impair concentration and judgment. Drinking a lot of alcohol can cause drunkenness (intoxication).
Some of the symptoms of alcoholism include:
- Abdominal pain
- Confusion
- Drinking alone
- Episodes of violence with drinking
- Hostility when confronted about drinking
- Lack of control over drinking -- being unable to stop or reduce alcohol intake
- Making excuses to drink
- Nausea and vomiting
- Need for daily or regular alcohol use to function
- Neglecting to eat
- Not caring for physical appearance
- Numbness and tingling
- Secretive behavior to hide alcohol use
- Shaking in the morning
Alcohol withdrawal develops because the brain adapts to the alcohol and cannot function well without the drug. Symptoms of withdrawal may include:
- Anxiety
- Confusion or seeing and hearing things that aren't there (hallucinations)
- Death (rarely)
- Increased blood pressure
- Loss of appetite, nausea, or vomiting
- Psychosis
- Raised temperature
- Rapid heart rate
- Restlessness or nervousness
- Seizures
- Tremors
Treatment
Those who are dependent need to stop drinking alcohol (abstinence). Those who are problem drinkers may be successful with moderation. Because many people refuse to believe that their drinking is out of control, trying moderation can often be an effective way to deal with the problem. If it succeeds, the problem is solved. If not, the person is usually ready to try abstinence.
Three general steps are involved in treatment once the disorder has been diagnosed:
- Intervention
- Detoxification
- Rehabilitation
INTERVENTION
Many people with alcohol problems don't recognize when their drinking gets out of hand. In the past, treatment providers believed that alcoholics should be confronted about their drinking problems, but now research has shown that compassion and empathy are more effective.
The ideal approach is to help people realize the negative impact alcohol abuse is having on their life, and on the lives of those around them. They can aim for a personal goal of leading a more fulfilling and sober life.
Studies find that more people enter treatment if their family members or employers are honest with them about their concerns, and try to help them see that drinking is preventing them from reaching their goals.
DETOXIFICATION
Withdrawal from alcohol is done in a controlled, supervised setting in which medications relieve symptoms. Detoxification usually takes 4 to 7 days.
Examination for other medical problems is necessary. For example, liver and blood clotting problems are common.
Eating a balanced diet with vitamin supplements is important. Complications can occur with alcohol withdrawal, such as delirium tremens (DT's), which could be fatal. Depression or other mood disorders should be evaluated and treated. Often, alcohol abuse develops from efforts to self-treat an illness.
REHABILITATION
After detoxification, alcohol recovery or rehabilitation programs can help people stay off alcohol. These programs usually offer counseling, psychological support, nursing, and medical care. Therapy involves education about alcoholism and its effects.
Many of the staff members at rehabilitation centers are recovering alcoholics who serve as role models. Programs can be inpatient, where patients live in the facility during the treatment. Or they can be outpatient, where patients attend the program while they live at home.
Medications are sometimes prescribed to prevent relapses.
- Acamprosate is a new drug that has been shown to lower relapse rates in those who are alcohol dependent.
- Disulfiram (Antabuse) produces very unpleasant side effects if you drink even a small amount of alcohol within 2 weeks after taking the drug.
- Naltrexone (Vivitrol) decreases alcohol cravings. It is available in an injected form.
You cannot take these medications if you are pregnant or have certain medical conditions. Long-term treatment with counseling or support groups is often necessary. The effectiveness of medication and counseling varies.
Prognosis
Only 15% of people with alcohol dependence seek treatment for this disease. Starting drinking again after treatment is common, so it is important to maintain support systems in order to cope with any slips and ensure that they don't turn into complete reversals.
Treatment programs have varying success rates, but many people with alcohol dependency make a full recovery.
Prevention
Educational programs and medical advice about alcohol abuse can help decrease alcohol abuse and its problems. Alcohol dependency needs more intensive management.
The National Institute on Alcohol Abuse and Alcoholism recommends that women have no more than 1 drink per day and men no more than 2 drinks per day. One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor.