Alcohol Use And Abuse

What is alcohol? What Is alcohol abuse? What is moderate drinking? Who is alcoholic?

Alcohol is a colorless, volatile, flammable fluid made from certain plants (corn, barley, rye, grains) or fruits  It is made by mixing these plants or fruits with yeast. The yeast feeds on the various sugars (starches) in these plants or fruits. The sugars are then converted into alcohol (and carbon dioxide). The process of alcohol production is called fermentation.

The alcohol people drink is called ethanol or ethyl alcohol.   The chemical formula for ethyl alcohol is C2H5OH.

Alcohol is quickly absorbed into the bloodstream after it has been swallowed. It then gets metabolised (broken down) in the liver. The problem is that the liver is unable to quickly metabolise large amounts of alcohol; it breaks down only a little alcohol at a time. So the excess alcohol continues to accumulate in the bloodstream.

The level of alcohol in the blood may be affected by gender (male or female), age, physical health, the amount of food recently eaten, and whether the person has taken certain medications or drugs. Thats why alcohol affects different people in different ways.

Depending on these factors  a person’s reaction may range from being slightly tipsy to being drunk.

Many people drink a small or moderate amount of alcohol to relax and enhance their social activities. Using alcohol in this way is not harmful for most adults.

People are said to have an alcohol problem when their use of alcohol has negative effects on any aspect of their lives including their health, relationships, work or school and money. These problems can range from mild to severe. The type of alcohol a person drinks, how much he or she drinks, and how long he or she has been drinking are also considered when determining whether a person has an alcohol problem.

Categories of Drinking:

Experts divide levels of alcohol use and abuse into the following categories in terms of risk for developing problems (considered below):

     1. Moderate drinking

     2. At-risk drinking

     3. Alcohol abuse

     4. Alcohol dependence, also called alcoholism

 1. What Is Moderate Drinking?

Moderate drinking is drinking that does not usually cause problems for the drinker or society and is considered low risk. In the United States, moderate drinking is usually defined as:

  • men: no more than two drinks per day.
  • women: no more than one drink per day.
  • over age 65: no more than one drink per day.

A standard drink is considered to be:

  • 12 ounces of beer or wine cooler;
  • 5 ounces of wine; or
  • 1.5 ounces of 80-proof distilled spirits.

The limit for women and all people over age 65 is lower because they have smaller amounts of water in their bodies than men age 65 and under. As a result, they reach the same concentration of alcohol in their blood after drinking a smaller amount of alcohol. In addition, more older people have medical conditions that can be worsened by alcohol and take medicines that can have harmful effects when mixed with alcohol.

These guidelines for moderate drinking do not apply to the following people, who should not drink alcohol at all:

  • women who are pregnant or trying to get pregnant;
  • people who are driving or operating machines;
  • people who are taking medicine that interacts with alcohol;
  • people who are recovering from alcohol dependence (alcoholism);
  • people with certain medical conditions where alcohol use would be harmful, such as ulcer and liver disease; and
  • children and adolescents (under age 21).

Although moderate drinking is generally considered low risk in terms of causing problems, some level of impairment can begin with the first drink. One example is decreased ability to concentrate and slower reflexes, which can lead to problems when driving or operating machines. Other health problems normally associated with heavier drinking can sometimes occur with low levels of alcohol use.

In recent years, there have been many media reports about possible benefits to the heart from moderate drinking. Evidence from research does show that moderate drinking (as opposed to not drinking or drinking larger amounts) is associated with decreased risk of death from heart disease. However, because drinking involves possible risks, people who drink little or no alcohol are not advised to drink more just to reduce their chance of developing heart disease. In addition, similar protective effects can be gained from a healthy diet and regular exercise.

 2. What Is At-Risk Drinking?

At-risk drinking is drinking that poses a risk of developing problems. A persons drinking habits are such that he is at risk of becoming addicted to alcohol.

It is considered to be:

  • men: more than 14 drinks per week or more than 4 drinks per sitting.
  • women: more than 7 drinks per week or more than 3 drinks per sitting.

 3. What Is Alcohol Abuse?

Alcohol abuse does not mean that a person is addicted to alcohol. It means that a person abuses the use of alcohol, drinking dangerously (such as to cause danger), can cause problems to his or her health, and harm relationships with family, friends and co-workers..  Continued alcohol abuse can lead to alcohol dependence.

Alcohol abuse is defined as a pattern of drinking that involves one or more of the following problems within a one-year period:

  • Continued drinking despite ongoing problems in relationships with other people that are related to alcohol use.
  • Drinking in physically dangerous situations, such as while driving
  • Failure to carry out major responsibilities at work, school, or home
  • Legal problems related to using alcohol

Alcohol abuse is different from alcohol dependence (where someone is addicted to alcohol – an alcoholic) because alcoholics are physically dependent on alcohol and do not have control over their drinking. However, sometimes it is hard to draw a clear line between them because alcohol abusers may experience many of the same effects that alcoholics do.

 4. What Is Alcohol Dependence?

Alcohol dependence, also called “alcoholism,” is a where a person is addicted to alcohol. It can be considered as a chronic disease. It may be difficult to cure. It can be successfully controlled.

Alcohol dependence is characterized by three or more of the following occurring in a one-year period:

  • Tolerance: increasing amounts of alcohol needed to get the same effect.
  • Withdrawal symptoms, such as shakiness, sweating, nausea, anxiety, and depression, when alcohol use is stopped after heavy drinking. Also, use of alcohol to relieve or avoid withdrawal symptoms.
  • Drinking larger amounts and for longer than you intended.
  • Inability to cut down or quit drinking.
  • Spending a lot of time getting and drinking alcohol or recovering from its effects.
  • Reducing or giving up important work or leisure activities.
  • Continued use despite the physical or emotional problems it causes to the drinker or other people.

Facts About Alcohol Use And Abuse

  • Almost 14 million Americans (1 in 13 adults) have problems with drinking alcohol. About 8 million of these people are alcoholic.
  • Several million more Americans drink in ways that could lead to alcohol problems.
  • About 50 percent of American adults have been affected by alcohol abuse or dependence in their family.
  • Alcohol abuse and dependence occurs about two to three times more often in males than females.
  • Alcohol problems are most common in the early adult years and lowest among people ages 65 and older, but they can occur at any age.
  • About 1 in 4 American children (19 million) is exposed at some time before age 18 to alcohol abuse or dependence in their family.
  • First experiences with getting drunk often occur in adolescence. The earlier people start drinking heavily, the higher the chance they will develop serious medical problems later.
  • People with alcoholism in their family are more likely to start drinking before age 20 and become dependent on alcohol.
  • Alcohol abuse and dependence can occur in all racial, cultural, and socioeconomic backgrounds, but some groups are at higher risk than others.

 


Alcoholism: How to help an alcoholic

First and foremost, keep in mind that an alcohol problem is a medical condition that needs and deserves treatment just like any other medical problem. It is not a personal or moral weakness and does not mean the drinker is trying to cause problems for you.

  1. Learn as much as you can. Once you have recognized that the person has an alcohol problem, learn as much as you can about alcohol abuse and dependence, how it can affect families and friends of a drinker, and what treatment options and support groups are available.
  2. If necessary, deal with your own denial of the problem. You may need to deal with any denial you have about the drinker’s alcohol problem. Family members and friends often make excuses for the drinker’s behavior and cover up problems caused by the drinker’s alcohol use. This is called “enabling.” (hyperlink glossary). It protects the drinker from the consequences of his or her alcohol use and allows the person to keep drinking.

    People enable a drinker in order to protect themselves, the drinker, and others. They may be trying to hide the feelings—such as shame, guilt, inadequacy, and resentment—caused by the person’s drinking. If you stop your enabling behavior, the drinker has to face the consequences of his or her behavior. This may make him or her more motivated to get help.

  3. Talk with the person about his or her alcohol use. You do not need to wait until the drinker brings up his or her alcohol problem or hits bottom. Since people with an alcohol problem often deny there is something wrong, they may need someone else to bring up the topic. Family and friends can do specific things to motivate an alcoholic person to seek help.

    The earlier an alcohol problem is identified, the easier it is to treat. Do not wait to take action. Your involvement could keep the drinker from experiencing serious consequences in his or her health and daily life.

  4. Provide support while the person is in treatment. During treatment the person will probably go through significant changes. The most important things you can do are to show you care and provide emotional support. Recovery can be a long process with several relapses. Try to be patient and understanding.

    Here are some suggestions for discussing a person’s alcohol problem:

    • Choose a time when the person is not drunk and the two of you are calm. The best time is soon after an alcohol-related problem has occurred.
    • Express your concern and be supportive. Do not criticize or blame the person.
    • Focus on the behavior and its consequences, not on the person.
    • Give specific examples of when the person’s alcohol use caused problems. Discuss the effects of his or her behavior on you and other people and things he or she cares about, such as children and career.
    • If the person is open to accepting help, provide information about treatment and support groups. Offer to help arrange an appointment and go to it or to take the person to a support group meeting.

Dealing With Denial

If the person denies having a problem or refuses help, do not take the person’s denial personally. Denial is a very common reaction in people with alcohol problems.

Listed below are possible next steps. Consider taking one or more of them.

  • Tell the person you would be glad to help when he or she is ready.
  • Provide the telephone number of a support group nearby, such as Alcoholics Anonymous.
  • Ask someone else close to the person, such as a family member or friend, to talk with him or her.
  • Talk with a mental health or substance abuse professional to get advice and support. He or she may suggest that you carry out an “intervention.”

What Is An Intervention?

An intervention is a planned action that a group of two or more people take by meeting with the person with an alcohol problem to get him or her to seek treatment. They are concerned about the alcoholic person and want to help him or her stop the destructive effects of drinking and develop new, healthier ways of coping.

In an intervention, the group tells the alcoholic person in a clear but caring way how the drinking is affecting them as well as the group members. This discussion should include specific examples. It is aimed at making the person with an alcohol problem face the effects of his or her drinking and generating motivation to seek treatment.

In some cases the alcoholic person is also given consequences that will occur if he or she does not seek treatment. For example, a spouse or partner may leave the alcoholic if he or she does not seek treatment. Although this may seem harsh, the intention is caring and the goal is to help the alcoholic person get treatment so that he or she can recover.

An intervention can be initiated by anyone who cares about the alcoholic person and is affected by his or her drinking, including a spouse, child, parent, friend, or employer. It should be done with the guidance of a professional who is trained in carrying out interventions. At the end, specific steps for seeking treatment should be suggested.

What Can I Do To Take Care Of Myself?

Be sure to take care of yourself while helping the drinker. Keep these points in mind:

  • The person’s drinking is not your fault, and you are not responsible for his or her recovery. You can only try to help the person deal with the problem.
  • Recovery from an alcohol problem can take a long time and involve several relapses and rounds of treatment. Try to be patient with this process.
  • If the drinker becomes violent toward you, immediately call for help from police and emergency services. Leave the area if possible.
  • Get support from other people.

Whether or not the drinker seeks help, you may want to share experiences, information and support with other people in your situation. Consider attending a support group like Al-Anon for family and friends of people with alcohol problems. To find a group in your area, look in the phone book or contact a hospital or alcohol treatment center near you. If you want professional counseling, talk with your health care provider or a mental health or substance abuse professional.

 

Alcohol Warning Signs

There are many signs of alcohol abuse and dependence. The combination of signs differs from person to person. Some people with alcohol dependence have trouble functioning in their every day life while others appear to be doing quite well. The one thing that all people who are dependent on alcohol have in common is loss of control over their drinking.

Keep in mind that a person does not have to drink every day to have an alcohol problem. Some alcoholics just binge on weekends or several times a month. What is most important is the effect that drinking has on the person’s health and life, not how often or how much he or she drinks.

Common Warning Signs

There are many subtle and not-so-subtle signs of a drinking problem. Here are some of the more common warning signs that a person may display:

  • Uses more alcohol than in the past;
  • Drinks a lot one or more times a week;
  • Denies or tries to hide or justify alcohol use;
  • Has trouble controlling alcohol use;
  • Forgets things he or she did or said while drinking;
  • Avoids you or others in order to drink;
  • Spends more time with heavy drinkers;
  • Uses alcohol instead of doing activities previously enjoyed;
  • Has problems with health, family, friends, work, school, or money that are caused by alcohol use;
  • Has significant mood changes during or after alcohol use;
  • Expresses concern or guilt about his or her drinking; and
  • Drives while under the influence of alcohol.

If the person has one or more of these signs, he or she may have an alcohol problem. The more of these signs the person has, the worse the problem is likely to be.

What Are The Barriers To Getting Diagnosed And Treated?

Factors related to the drinker and the doctor often delay or prevent diagnosis and treatment of an alcohol problem. This leaves many people with a pattern of abuse or dependence that continues to worsen and becomes harder to treat.

People who misuse alcohol often deny they have a problem. The effects of chronic drinking interfere with people’s thinking and affect their attitudes and behavior. They may not see the harm their drinking is causing to themselves and others.

Even when people can see the consequences of their drinking, they may not want to admit them—or that they are related to their drinking. Denial protects them from the negative reactions of other people and from their own guilt, shame, and pain. Family members and friends may also get caught up in the denial and fail to help the person get diagnosed.

Doctors often fail to detect alcohol problems in their patients. Many do not perform screening tests for alcohol problems nor recognize the symptoms. They may not have adequate training in alcohol problems. As a result, they may attribute symptoms from alcohol use to other causes, have negative attitudes toward people with alcohol problems, or be reluctant to bring up the issue. In addition, because people with alcohol problems often have an accompanying disorder such as depression, it can sometimes be tricky to make a correct diagnosis.


How Can I Cut Down On My Drinking?

This section is for people who want to cut down on their drinking.

If you are dependent on alcohol or have a medical problem that can be worsened by alcohol, you aim should be to stop drinking completely. 

Steps to cut down your drinking

  • Write a list of your reasons for cutting down or stopping.
  • Set a goal for your drinking — either a limit on how much you will drink or to stop completely. Write your goal on a piece of paper. Put it in a place where you will see it often, e.g. on your refrigerator or a mirror.
  • Keep a “diary” of your drinking to help you reach your goal. Every time you drink, write down how much you drink and the circumstances in which you are drinking. Note what triggers your drinking so that you can learn how to avoid or cope with these things. Also use the diary to see and appreciate the progress you are making. Write down the times that you choose not to drink.
  • Keep only a small amount or no alcohol in your home.
  • Drink slowly. Take a one-hour break between drinks. Eat food when you are drinking.
  • Choose one or two days every week to not drink at all. Then try stopping for a week or longer.
  • Get support from your family and friends to help you cut down on your drinking.
  • Learn to say “no” when people try to persuade you to drink.
  • Avoid or reduce your exposure to people and places that trigger your drinking.
  • Get involved in new activities and social groups where drinking is less important or does not occur.
 

Problems Caused By Alcohol

Both alcohol abuse and alcohol dependence can cause many different types of problems that can disrupt a person’s life. They include health, emotional, social, work or school, and financial problems.

Health problems

The short-term effects of alcohol on the body include:

  • upset stomach;
  • diarrhea;
  • lack of coordination and judgment;
  • headaches; and
  • insomnia.

Misuse of alcohol can cause many different long-term problems because the whole body is affected. Some of these problems can lead to death. (Hyperlink all topics in this list to their article in the HIP library if there is an article about them.)

  • Heart disease: high blood pressure, irregular heartbeats, heart damage, heart failure
  • Cancer (mainly in conjunction with the cancerous effects of other substances, such as cigarette smoke);
  • Liver problems: liver damage, hepatitis, cirrhosis, cancer;
  • Problems of the stomach, lungs, kidneys, skin, muscle, and bones;
  • Infections (alcohol suppresses the immune system.);
  • Mental disorders: problems with attention, learning, and memory;<a data-cke-saved-href=”https://yourmedicalsource.com/library/what-depression” href=”https://yourmedicalsource.com/library/what-depression” _blank”=””>depression</a>; mood swings; <a data-cke-saved-href=”https://yourmedicalsource.com/library/what-are-anxiety-disorders” href=”https://yourmedicalsource.com/library/what-are-anxiety-disorders” target=”_blank”>anxiety</a> disorders;</li> <li><a data-cke-saved-href=”https://yourmedicalsource.com/library/what-insomnia” href=”https://yourmedicalsource.com/library/what-insomnia” target=”_blank”>Insomnia</a>;</li> <li>Malnutrition; and</li> <li><a data-cke-saved-href=”https://yourmedicalsource.com/library/what-erectile-dysfunction” href=”https://yourmedicalsource.com/library/what-erectile-dysfunction” target=”_blank”>Impotence</a> and <a data-cke-saved-href=”https://yourmedicalsource.com/library/what-infertility” href=”https://yourmedicalsource.com/library/what-infertility” target=”_blank”>infertility</a> in men.</li> </ul> <p>Women who drink while pregnant have an increased chance of miscarriage. Babies of mothers who drink may be born at a low birth weight and with physical, mental, and behavioral problems. Many of these problems last into adulthood.</p> <p>Alcohol abuse and dependence also substantially increase the risk of accidents and violent behavior. For example, alcohol plays a major part in over half of all deaths from car accidents. Misuse of alcohol increases the risk of rape, domestic violence, child abuse, suicide, and murder.</p> <h2><a data-cke-saved-name=”Heading194″ name=”Heading194″></a>Social Problems</h2> <p>Alcohol use can make mild social problems worse by causing people to be more irritable and likely to argue and by affecting judgment and control of behavior. Alcohol use can also be the topic of arguments.</p> <p>Misuse of alcohol can lead to a number of moderate and serious social problems including:</p> <ul> <li>losing friends;</li> <li>losing jobs;</li> <li>child abuse and domestic violence;</li> <li>separation of family members; and</li> <li>divorce.</li> </ul> <h2><a data-cke-saved-name=”Heading206″ name=”Heading206″></a>Work Or School Problems</h2> <p>Misuse of alcohol may cause performance at work or school to suffer in ways such as:</p> <ul> <li>arriving late;</li> <li>making more mistakes;</li> <li>leaving assignments incomplete;</li> <li>problems with bosses and co-workers;</li> <li>getting poor grades or evaluations;</li> <li>flunking out of school; and</li> <li>losing jobs.</li> </ul> <h2><a data-cke-saved-name=”Heading218″ name=”Heading218″></a>Financial Problems</h2> <p>Misuse of alcohol may make current money problems worse and cause new ones, including:</p> <ul> <li>having less money for necessary expenses like food and clothing;</li> <li>neglecting to pay bills; and</li> <li>creating additional expenses, such as extra medical costs, fines, or car repairs.</li> </ul>

Am I Alcoholic?

This quiz can help you learn more about your use of alcohol and whether you may have an alcohol problem. It is called AUDIT (Alcohol Use Disorders Identification Test) and was developed by the World Health Organization.

Use the print button on your browser to print the test. Choose one answer for each question, then write the number in parentheses next to your answer on the line to the right of each question.

1. How often do you have a drink containing alcohol?

_____

(0) Never

(1) Monthly or less

(2) 2 to 4 times a month

(3) 2 to 3 times a week

(4) 4 or more times a week

 

2. How many drinks containing alcohol do you have on a typical day when you are drinking?

_____

(0) 1 or 2

(1) 3 or 4

(2) 5 or 6

(3) 7 to 9

(4) 10 or more

 

3. How often do you have six or more drinks on one occasion?

_____

(0) Never

(1) Less than monthly

(2) Monthly

(3) Weekly

(4) Daily or almost daily

 

4. How often during the last year have you found that you could not stop drinking once you had started?

_____

(0) Never

(1) Less than monthly

(2) Monthly

(3) Weekly

(4) Daily or almost daily

 

5. How often during the last year have you failed to do what was normally expected from you because of drinking?

_____

(0) Never

(1) Less than monthly

(2) Monthly

(3) Weekly

(4) Daily or almost daily

 

6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?

_____

(0) Never

(1) Less than monthly

(2) Monthly

(3) Weekly

(4) Daily or almost daily

 

7. How often during the last year have you had a feeling of guilt or remorse after drinking?

_____

(0) Never

(1) Less than monthly

(2) Monthly

(3) Weekly

(4) Daily or almost daily

 

8. How often during the last year have you been unable to remember what happened the night before because you had been drinking?

_____

(0) Never

(1) Less than monthly

(2) Monthly

(3) Weekly

(4) Daily or almost daily

 

9. Have you or someone else been injured because of your drinking?

_____

(0) No

(2) Yes, but not in the last year

(4) Yes, during the past year

 

10. Has a relative, friend, doctor, or other health care worker been concerned about your drinking or suggested you cut down?

_____

(0) No

(2) Yes, but not in the last year

(4) Yes, during the past year

 
   
   

Now add up the numbers in all the boxes. Write the total here.

_____

If the total is 8 or more, you may have an alcohol problem. You may want to talk with your doctor or a mental health or alcohol abuse professional to get help.

What Causes Alcoholism?

Alcoholism is caused by a combination of genetic, environmental, biological, and psychological factors. Alcoholism often runs in families. This is partially due to genetic factors. Researchers are currently trying to determine which genes are responsible for making some people more vulnerable to alcoholism.

Although genetics is involved in many cases of alcoholism, children of alcoholic parents do not necessarily become alcoholic. In addition, people with no family history of the disease can develop alcoholism.

Environmental factors also may affect drinking and the development of alcohol abuse and alcoholism. They include:

  • influence of family and friends;
  • cultural attitudes and practices;
  • ease of obtaining alcohol; and
  • stress.

When people become dependent on alcohol their brains change in ways that keep them dependent, such as having cravings for alcohol, withdrawal symptoms, and relapses. These things make the disease worse. Researchers are studying the roles of the neurotransmitters (chemical messengers in the brain) dopamine, serotonin, and GABA in alcoholism because they are strongly associated with cravings and emotional behavior.

Depression and anxiety disorders also increase people’s risk of developing alcohol problems. People may use alcohol to help deal with symptoms of these disorders. Major depression occurs along with one-third of all cases of alcoholism. However, in some people depression and anxiety can be caused by the alcohol dependence and go away after they withdraw from alcohol.


Treating Alcohol Abuse

People with an alcohol problem who are not dependent on alcohol can often control their problem just with support from a health care provider and family or friends. They also may choose to attend meetings of Alcoholics Anonymous or another support group. 

You may choose to cut down on your drinking or quit. Either way you need to look at:

  • your drinking patterns;
  • the situations that trigger your drinking;
  • the resulting problems; and
  • the pros and cons of cutting down and of quitting.

Next, decide on a drinking goal (whether it is cutting down or quitting) and ways to handle your trigger situations and other difficulties of maintaining your goal.

Treating alcoholism is a much more involved process because alcoholics need to break their dependence on alcohol and deal with a large array of problems caused by their drinking. Alcoholism can be successfully treated and managed but not cured. Abstinence is usually the goal since most alcoholics are not able to control their drinking through just cutting down.

The first step in quitting drinking for a person with alcoholism is to deal with the withdrawal symptoms. Long-term treatment can involve cognitive-behavioral therapy (see below), support groups, and/or medication to regain health, deal with other problems caused by drinking, and maintain abstinence. Treatment needs to be tailored to the individual’s specific needs.

Treatment For Alcohol Withdrawal

About 95 percent of people who experience withdrawal symptoms have mild or moderate ones, such as trembling, agitation, sleep problems, and lack of appetite. Most people with mild symptoms do not seek treatment for them. About 15 to 20 percent of people with moderate symptoms have brief seizures and hallucinations but can usually be treated with medication as outpatients.

People with severe symptoms are usually treated as inpatients in a hospital or alcohol treatment center. They often have full-blown seizures or delirium tremens. Treatment with medication and monitoring of their condition are needed. The program they participate in is often referred to as “detoxification,” or “detox” for short. Detoxification is the process of getting alcohol out of the body.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy is a type of psychotherapy that focuses on 1) changing unproductive thought patterns to help change how you feel and 2) changing and gaining control over unwanted behaviors. In the treatment of alcoholism it is used to help people:

  • change the way they think about and use alcohol;
  • identify and avoid things that trigger their drinking;
  • develop strategies to cope with cravings for alcohol; and
  • make changes in lifestyle that increase involvement in activities not related to alcohol use and reduce contact with drinkers.

Support Groups

Support groups provide an opportunity for people with alcohol problems to share experiences and support and learn from each other. Attending support group meetings reinforces the person’s commitment to recovery and can be a major help in staying sober over the long term. They also provide a chance to get to know other people in an alcohol-free environment who are trying not to drink.

There are several national self-help organizations that focus on abstinence and provide support groups throughout the United States. Each one has a different approach. Alcoholics Anonymous (AA) is the largest, oldest, and most well known of these organizations. It is based on a 12-step program for recovery. Two other groups are Secular Organizations for Sobriety (SOS) and Women for Sobriety (WFS).

Al-Anon provides support groups for family and friends of people with alcohol problems. It is associated with Alcoholics Anonymous and also based on a 12-step approach.

Medication

Two medications are currently approved by the U.S. Food and Drug Administration (FDA) to treat alcoholism over the long term. They are used in conjunction with other forms of treatment.

Disulfiram (Antabuse) discourages alcohol use by causing unpleasant symptoms when a person drinks alcohol while taking it. The symptoms include flushing, nausea, and vomiting. Disulfiram has not been shown to increase the rate of abstinence, but it helps some people who relapse to drink less. The potential for dangerous reactions limits its use.

Naltrexone (ReVia) decreases alcohol use by reducing the pleasurable effects of alcohol and cravings. It can be very effective, especially when used with counseling or support groups. The most common side effect is short-term nausea. High doses can cause liver damage.

Acamprosate (Campral) decreases alcohol use by reducing cravings. It may sometimes cause diarrhea. Acamprosate is currently being sold in Europe and is under review by the FDA for use in the United States.

Other medications, including antidepressants and anti-anxiety medications, are sometimes used to prevent relapse. Research is ongoing to develop new medications and refine the roles of existing ones.


Outcomes

Without treatment, alcohol abuse can develop into alcohol dependence. Alcohol dependence is often progressive and fatal. This means that without treatment it continues to get worse and can lead to death. Death can occur through overdose or by health problems, accidents, or suicide caused by excessive drinking.

Many people who are not dependent on alcohol can recover from an alcohol problem on their own or with the help of a support group. But some people do need the assistance of a treatment program.

People who are dependent on alcohol almost always need help to recover – both professional help and extensive support from family and friends. Since there is no cure for alcohol dependence, recovery means withdrawing from alcohol and managing the disease on a long-term basis. For most alcoholics this involves complete abstinence from alcohol. If the person stops drinking, alcohol-induced health problems can often be brought under control or prevented.

Recovering from alcohol dependence can be a long process and often requires several rounds of treatment. Relapse occurs in about 50 percent of cases within the first year of treatment. However, relapses are usually temporary setbacks in the recovery process, just like flare-ups of other chronic diseases. They are not a failure of the person or treatment. What is important is that the person learns from the experience, tries again to stop drinking, and gets additional support to keep from drinking.

Getting Help

Do not be afraid to ask for help for an alcohol problem. Remember that an alcohol problem is not a personal or moral weakness. It is an illness that deserves treatment like any other medical condition. The earlier you get help, the better your chance of avoiding or reducing the harmful problems that can be caused by misuse of alcohol. You will also have a better chance of successful recovery.

If you think you have an alcohol problem, talk with your health care provider or a mental health or substance abuse professional, or call any of the organizations listed in the section “Additional Sources of Information.”


Frequently Asked Questions:Alcohol Use And Abuse

Here are some frequently asked questions related to alcohol use and abuse.

Q: Do all alcohol abusers and alcoholics drink a lot every day?

A: No. For some people, large amounts of alcohol are not necessary to make them develop an alcohol problem and become dependent on alcohol. Some alcoholics just binge on weekends or several times a month. The important thing is not when or how often people drink, but what happens when they drink and whether they have control over their drinking.

Q: What is a blackout?

A: A blackout is a period of amnesia caused by overuse of alcohol. It is different from passing out because in a blackout the person is fully conscious. The person seems fully aware of what s/he is doing and saying and in full control. However, after the blackout, the person has no memory of what s/he did or said during that time period. A blackout can last for anywhere from seconds to days.

Q: What other disorders often occur along with alcohol problems?

A: People may use alcohol to help deal with the symptoms of depression and anxiety disorders. However, depression and anxiety may also be caused by alcoholism, in which case they often go away after withdrawal from alcohol. Another problem that can go along with an alcohol problem is abuse of and dependence on other drugs, such as marijuana, cocaine, heroin, amphetamines, sedatives, and nicotine. A person may use alcohol to get rid of unpleasant effects of these substances or to replace them when they are not available.

Q: Do I have to stop drinking if I am taking prescription or over-the-counter medicine?

A: Possibly. More than 100 medicines interact in harmful ways with alcohol. The effects of alcohol are greater with medicines that slow the central nervous system, such as antihistamines, antidepressants, sleeping pills, anti-anxiety medicines, and some painkillers. Medicines for certain disorders, such as heart disease and diabetes, can be dangerous when used with alcohol. If you are taking any prescription or over-the-counter medicines, talk with your doctor or pharmacist about whether it is safe for you to drink any alcohol.

Q: Is it safe to drink while I am pregnant?

A: No. Drinking during pregnancy can increase the chance of miscarriage. Babies of mothers who drink may be born at a low birth weight and with physical, mental, and behavioral problems, including mental retardation. Many of these problems last into adulthood. Even moderate amounts of alcohol can have harmful effects on the fetus. Since the exact amount of alcohol that starts to cause problems is not known, abstaining from alcohol is the one option that experts know is always safe.

Q: Is there a relationship between drinking and sleep?

A: Yes. Alcohol use before going to sleep can interfere with normal sleep patterns. It can also help start or worsen sleep disorders such as apnea. People who use alcohol to help them sleep may fall asleep more easily. However, their sleep in later hours is fitful, leaving them tired the next day. In addition, when a person has less sleep and is tired, it is easier for alcohol to affect the body.

Q: Is there a connection between drinking and smoking?

A: Between 80 and 95 percent of alcoholics smoke cigarettes. That’s three times the average rate. Smokers develop alcoholism at a rate 10 times higher than nonsmokers. The combination of smoking and drinking makes health problems worse than just smoking or drinking alone. This is especially true for some types of cancer.

Q: Is there a connection between drinking and violent behavior?

A: Misuse of alcohol is found in many cases of rape, domestic violence, child abuse, suicide, and murder. In addition, people who have experienced domestic violence or child abuse have a higher chance of becoming alcohol abusers. Alcohol itself does not cause violent behavior. However, it may increase the risk of violent behavior in certain people. This occurs in part because alcohol impairs judgment and reduces impulse control. Cultural and other environmental factors may also play a significant role.

Q: Is there a relationship between drinking and risky sexual behavior?

A: People are more likely to engage in casual sex after drinking than when they are sober. Alcohol impairs judgment about having sex and using birth control and safe sex methods. This increases the chance of rape, unwanted pregnancy, and infection with sexually transmitted diseases including HIV.

Q: What should I know about drinking and driving?

A: Alcohol is involved in more than half of all deaths from car accidents. Each year about 17,000 Americans are killed in alcohol-related traffic accidents, thousands are permanently disabled, and almost one million are injured. Alcohol impairs reflexes, coordination, vision, perception, and judgment. Impairment starts with the first drink. Most people are very impaired before they have become legally drunk. Alcohol can cause a person to have a car accident even if s/he generally does not abuse it. People who abuse alcohol are at higher risk. The term “drunk driver” also refers to people who are drunk while riding bicycles or motorcycles, or operating boats or snowmobiles.

Q: When is inpatient treatment recommended?

A: Inpatient treatment is recommended for people:

  • with severe withdrawal symptoms;
  • with a severe case of another medical or psychiatric disorder;
  • who may hurt themselves or others;
  • do not respond to other treatments; or
  • have a very disruptive home environment that interferes with treatment.

An inpatient setting provides a safe, medically supervised, alcohol-free environment where a person can stop drinking and begin a treatment program.

Q: How important is it for the person to be committed to treatment and recovery?

A: Motivation and commitment are very important in helping a person seek treatment, follow through with it, and maintain abstinence or other necessary changes in his or her drinking patterns over the long term.

Q: Can treatment be useful if it is not voluntary?

A: Yes. Sanctions or rewards in the family, work setting, or criminal justice system can increase motivation to change, entry into treatment, and success of results.

Q: Isn’t it mainly working class and low-income families that experience alcohol problems?

A: No. Alcohol problems occur in families of all economic and educational backgrounds as well as racial and cultural backgrounds. However, certain groups do have a somewhat higher risk for alcohol problems.

Q: Could a family member or friend I see every day have an alcohol problem if I do not see him or her drinking much?

A: Yes. A person does not have to drink every day to have an alcohol problem. Some alcoholics just binge on weekends or several times a month. It is common for people with alcohol problems to hide their drinking and its consequences.

Q: What are some examples of enabling behavior?

A:

  • Lying to other people about the person’s drinking.
  • Giving excuses for problems caused by the person’s drinking.
  • Accepting the person’s excuses in order to avoid conflict.
  • Taking care of the person’s responsibilities, such as financial responsibilities.
  • Getting the person out of financial or legal problems.

Q: How important is it for the drinker to be committed to treatment and recovery?

A: Motivation and commitment are essential in helping someone seek treatment, follow through with it, and maintain abstinence or other necessary changes in his or her drinking patterns over the long term.

Q: Can treatment be useful if it is not voluntary?

A: Yes. Sanctions or rewards in the family, work setting, or criminal justice system can increase motivation to change, entry into treatment, and success of results.

Q: What are some ways a specialist in alcohol problems or another mental health professional can be helpful?

A:

  • Help you figure out whether a family member or friend may have an alcohol problem.
  • Help you figure out how to talk with the drinker and give advice and support in planning an intervention.
  • Attend an intervention if needed, for example if the drinker has a history of mental illness or violence.
  • Help you cope with the difficulties and stress of having a family member or friend with an alcohol problem.

Q: What if an intervention fails?

A: An intervention cannot fail. Even if the alcoholic person does not seek treatment, everyone involved in the intervention has some new awareness. After an intervention, it is harder for anyone to retreat into denial. A second or third intervention may then be more likely to succeed in getting the alcoholic person to accept treatment because his or her defenses were probably weakened by the first intervention.

 

Putting It All Together: Alcohol Use And Abuse

Here is a summary of the important facts and information related to alcohol use and abuse.

  • “Moderate drinking” is drinking that does not usually cause problems for the drinker or society.
  • People are considered to have an alcohol problem when their alcohol use has a negative effect on their life. The type of alcohol used, how much, and for how long, are also involved.
  • Misuse of alcohol can cause many types of problems, including health, social, work or school, and financial problems.
  • Alcohol dependence, also called “alcoholism,” is a chronic and potentially fatal disease in which a person is addicted to alcohol. People with alcoholism do not have control over their drinking.
  • Alcoholism is caused by a combination of genetic, environmental, biological, and psychological factors.
  • Alcoholism cannot be cured, but it can be successfully controlled. The main forms of treatment are cognitive-behavioral therapy, support groups, and medication.
  • People with alcoholism usually have to abstain from alcohol in order to control their disease. People with other alcohol problems may be able to control them by cutting down on their drinking.
  • An alcohol problem is not a personal weakness. It is a disease that deserves treatment like any other medical condition.
  • Family and friends are not responsible for the drinking of a loved one, but they can provide valuable support to help the person deal with his or her alcohol problem.
  • About 50 percent of American adults have been affected by alcohol abuse or dependence in their family.
  • Family and friends must deal with any denial they may have about the drinker’s problem. If they stop protecting themselves, the drinker and others from the problem, the drinker then has to face the consequences of his or her behavior and may become more motivated to get help.
  • Do not wait to help until the person who drinks too much brings up the problem or hits bottom. The earlier the drinker gets help, the better the chance of successful recovery.
  • Provide support in helping the person with an alcohol problem accept his or her problem, seek treatment, go through treatment, and avoid relapse.
  • Take care of yourself while you help the drinker.
  • The earlier a drinker gets help, the better the chance of successful recovery.

Glossary: Alcohol Use And Abuse

Here are definitions of medical terms related to alcohol use and abuse.

Alcohol abuse: A pattern of alcohol use that causes problems in any aspect of a person’s life.

Alcohol dependence (alcoholism): Alcohol dependence, also called “alcoholism,” is a chronic, progressive, and potentially fatal disease in which a person is physically dependent on alcohol. The person has strong cravings to drink, withdrawal symptoms when s/he stops drinking, a tolerance to alcohol, and lack of control over his or her drinking.

Alcoholic: A person who is dependent on alcohol and has the disease of alcoholism.

At-risk drinking: Drinking that poses a risk of developing problems. Men: more than 14 drinks per week or more than 4 drinks per sitting. Women: more than 7 drinks per week or more than 3 drinks per sitting.

Blackout: A period of amnesia caused by overuse of alcohol. It is different from passing out because in a blackout the person is fully conscious.

Cirrhosis: A disease in which damage to the liver causes a decrease in the liver’s ability to work properly. Excessive alcohol use can cause cirrhosis, which can lead to death.

Cognitive-behavioral therapy: A type of psychotherapy that focuses on 1) changing unproductive thought patterns to help change how you feel and 2) changing and gaining control over unwanted behaviors.

Delirium tremens: A state of confusion accompanied by trembling and hallucinations.

Detoxification: (often called just “detox”): The process of getting alcohol out of the body.

Moderate drinking: Drinking that does not usually cause problems for the drinker or society and is considered low risk. Men: no more than two drinks per day. Women: no more than one drink per day. Over age 65: no more than one drink per day.

Sober: A state in which no alcohol (or other mind-altering substance) has been used.

Sobriety: A life free of alcohol.

Tolerance: Decreased response to alcohol over time, which causes a need to increase the amount of alcohol used to get the same effect.

Withdrawal: Symptoms experienced when drinking alcohol is stopped or reduced significantly.


Additional Sources Of Information: Alcohol Use And Abuse

Here are some reliable sources that can provide more information on alcohol use and abuse.

National Clearinghouse for Alcohol and Drug Information

1-800-729-6686

http://www.health.org/

National Drug and Alcohol Treatment Referral Routing Service

1-800-662-HELP (1-800-662-4357)

http://www.health.org/phone.htm

National Institute on Alcohol Abuse and Alcoholism

(301) 443-3860

http://www.niaaa.nih.gov/

National Council on Alcoholism and Drug Dependence

1-800-NCA-CALL (1-800-622-2255)

http://www.ncadd.org/

Alcoholics Anonymous (AA) World Services

(212) 870-3400. Or check your local phone book or newspapers for groups in your area.

http://www.alcoholics-anonymous.org/

Al-Anon Family Group Headquarters (for family and friends of people with an alcohol problem)

1-800-344-2666. Or check your local phone book or newspapers for groups in your area.

http://www.al-anon.alateen.org/

Secular Organizations for Sobriety (SOS)

(310) 821- 8430

http://www.cfiwest.org/sos

Women for Sobriety

1-800-333-1606 or (215) 535-8026

http://www.womenforsobriety.org/

Rational Recovery Systems (for alcohol and any other type of drugs)

1-800-303-2873 or (530) 621-2667

http://www.rational.org/recovery


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