ALCOHOLISM
Getting the Facts
For
many people, the facts about alcoholism are not clear. What is
alcoholism, exactly? How does it differ from alcohol abuse? When
should a person seek help for a problem related to his or her
drinking? The National Institute on Alcohol Abuse and Alcoholism
(NIAAA) has prepared this booklet to help individuals and families
answer these and other common questions about alcohol problems.
The following information explains both alcoholism and alcohol
abuse, the symptoms of each, when and where to seek help, treatment
choices, and additional helpful resources.
A Widespread Problem
For
most people who drink, alcohol is a pleasant accompaniment to
social activities. Moderate alcohol use—up to two drinks
per day for men and one drink per day for women and older people—is
not harmful for most adults. (A standard drink is one 12-ounce
bottle or can of either beer or wine cooler, one 5-ounce glass
of wine, or 1.5 ounces of 80-proof distilled spirits.) Nonetheless,
a large number of people get into serious trouble because of their
drinking. Currently, nearly 14 million Americans—1 in every
13 adults—abuse alcohol or are alcoholic. Several million
more adults engage in risky drinking that could lead to alcohol
problems. These patterns include binge drinking and heavy drinking
on a regular basis. In addition, 53 percent of men and women in
the United States report that one or more of their close relatives
have a drinking problem.
The
consequences of alcohol misuse are serious—in many cases,
life threatening. Heavy drinking can increase the risk for certain
cancers, especially those of the liver, esophagus, throat, and
larynx (voice box). Heavy drinking can also cause liver cirrhosis,
immune system problems, brain damage, and harm to the fetus during
pregnancy. In addition, drinking increases the risk of death from
automobile crashes as well as recreational and on-the-job injuries.
Furthermore, both homicides and suicides are more likely to be
committed by persons who have been drinking. In purely economic
terms, alcohol-related problems cost society approximately $185
billion per year. In human terms, the costs cannot be calculated.
What Is Alcoholism?
Alcoholism,
also known as “alcohol dependence,” is a disease that
includes four symptoms:
•
Craving: A strong need, or compulsion, to drink.
•
Loss of control: The inability to limit one’s drinking
on any given occasion.
• Physical dependence: Withdrawal symptoms,
such as nausea, sweating, shakiness, and anxiety, occur when alcohol
use is stopped after a period of heavy drinking.
• Tolerance: The need to drink greater
amounts of alcohol in order to “get high.”
People who are not alcoholic sometimes do not understand why an
alcoholic can’t just “use a little willpower”
to stop drinking. However, alcoholism has little to do with willpower.
Alcoholics are in the grip of a powerful “craving,”
or uncontrollable need, for alcohol that overrides their ability
to stop drinking. This need can be as strong as the need for food
or water.
Although
some people are able to recover from alcoholism without help,
the majority of alcoholics need assistance. With treatment and
support, many individuals are able to stop drinking and rebuild
their lives.
Many
people wonder why some individuals can use alcohol without problems
but others cannot. One important reason has to do with genetics.
Scientists have found that having an alcoholic family member makes
it more likely that if you choose to drink you too may develop
alcoholism. Genes, however, are not the whole story. In fact,
scientists now believe that certain factors in a person’s
environment influence whether a person with a genetic risk for
alcoholism ever develops the disease. A person’s risk for
developing alcoholism can increase based on the person’s
environment, including where and how he or she lives; family,
friends, and culture; peer pressure; and even how easy it is to
get alcohol.
What Is
Alcohol Abuse?
Alcohol
abuse differs from alcoholism in that it does not include an extremely
strong craving for alcohol, loss of control over drinking, or
physical dependence. Alcohol abuse is defined as a pattern of
drinking that results in one or more of the following situations
within a 12-month period:
• Failure to fulfill major
work, school, or home responsibilities;
• Drinking in situations that are physically
dangerous, such as while driving a car or operating machinery;
• Having recurring alcohol-related legal problems,
such as being arrested for driving under the influence of alcohol
or for physically hurting someone while drunk; and
• Continued drinking despite
having ongoing relationship problems that are caused or worsened
by the drinking.
Although
alcohol abuse is basically different from alcoholism, many effects
of alcohol abuse are also experienced by alcoholics.
What Are
the Signs of a Problem?
How
can you tell whether you may have a drinking problem? Answering
the following four questions can help you find out:
•
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 (as an “eye opener”) to steady your nerves
or get rid of a hangover?
One
“yes” answer suggests a possible alcohol problem.
If you answered “yes” to more than one question, it
is highly likely that a problem exists. In either case, it is
important that you see your doctor or other health care provider
right away to discuss your answers to these questions. He or she
can help you determine whether you have a drinking problem and,
if so, recommend the best course of action.
Even
if you answered “no” to all of the above questions,
if you encounter drinking-related problems with your job, relationships,
health, or the law, you should seek professional help. The effects
of alcohol abuse can be extremely serious—even fatal—both
to you and to others.
The Decision To Get Help
Accepting
the fact that help is needed for an alcohol problem may not be
easy. But keep in mind that the sooner you get help, the better
are your chances for a successful recovery.
Any
concerns you may have about discussing drinking-related problems
with your health care provider may stem from common misconceptions
about alcoholism and alcoholic people. In our society, the myth
prevails that an alcohol problem is a sign of moral weakness.
As a result, you may feel that to seek help is to admit some type
of shameful defect in yourself. In fact, alcoholism is a disease
that is no more a sign of weakness than is asthma. Moreover, taking
steps to identify a possible drinking problem has an enormous
payoff—a chance for a healthier, more rewarding life.
When
you visit your health care provider, he or she will ask you a
number of questions about your alcohol use to determine whether
you are having problems related to your drinking. Try to answer
these questions as fully and honestly as you can. You also will
be given a physical examination. If your health care provider
concludes that you may be dependent on alcohol, he or she may
recommend that you see a specialist in treating alcoholism. You
should be involved in any referral decisions and have all treatment
choices explained to you.
Getting Well
Alcoholism Treatment
The
type of treatment you receive depends on the severity of your
alcoholism and the resources that are available in your community.
Treatment may include detoxification (the process of safely getting
alcohol out of your system); taking doctor-prescribed medications,
such as disulfiram (Antabuse®) or naltrexone (ReVia™),
to help prevent a return (or relapse) to drinking once drinking
has stopped; and individual and/or group counseling. There are
promising types of counseling that teach alcoholics to identify
situations and feelings that trigger the urge to drink and to
find new ways to cope that do not include alcohol use. These treatments
are often provided on an outpatient basis.
Because
the support of family members is important to the recovery process,
many programs also offer brief marital counseling and family therapy
as part of the treatment process. Programs may also link individuals
with vital community resources, such as legal assistance, job
training, childcare, and parenting classes.
Alcoholics Anonymous
Virtually
all alcoholism treatment programs also include Alcoholics Anonymous
(AA) meetings. AA describes itself as a “worldwide fellowship
of men and women who help each other to stay sober.” Although
AA is generally recognized as an effective mutual help program
for recovering alcoholics, not everyone responds to AA’s
style or message, and other recovery approaches are available.
Even people who are helped by AA usually find that AA works best
in combination with other forms of treatment, including counseling
and medical care.
Can Alcoholism Be Cured?
Although
alcoholism can be treated, a cure is not yet available. In other
words, even if an alcoholic has been sober for a long time and
has regained health, he or she remains susceptible to relapse
and must continue to avoid all alcoholic beverages. “Cutting
down” on drinking doesn’t work; cutting out alcohol
is necessary for a successful recovery.
However,
even individuals who are determined to stay sober may suffer one
or several “slips,” or relapses, before achieving
long-term sobriety. Relapses are very common and do not mean that
a person has failed or cannot recover from alcoholism. Keep in
mind, too, that every day that a recovering alcoholic has stayed
sober prior to a relapse is extremely valuable time, both to the
individual and to his or her family. If a relapse occurs, it is
very important to try to stop drinking once again and to get whatever
additional support you need to abstain from drinking.
Help for Alcohol Abuse
If
your health care provider determines that you are not alcohol
dependent but are nonetheless involved in a pattern of alcohol
abuse, he or she can help you to:
•
Examine the benefits of stopping an unhealthy drinking pattern.
• Set a drinking goal for yourself. Some people
choose to abstain from alcohol. Others prefer to limit the amount
they drink.
• Examine the situations that trigger your
unhealthy drinking patterns, and develop new ways of handling
those situations so that you can maintain your drinking goal.
Some
individuals who have stopped drinking after experiencing alcohol-related
problems choose to attend AA meetings for information and support,
even though they have not been diagnosed as alcoholic.
New Directions
With
NIAAA’s support, scientists at medical centers and universities
throughout the country are studying alcoholism. The goal of this
research is to develop better ways of treating and preventing
alcohol problems. Today, NIAAA funds approximately 90 percent
of all alcoholism research in the United States. Some of the more
exciting investigations focus on the causes, consequences, treatment,
and prevention of alcoholism:
• Genetics: Alcoholism is a complex
disease. Therefore, there are likely to be many genes involved
in increasing a person’s risk for alcoholism. Scientists
are searching for these genes, and have found areas on chromosomes
where they are probably located. Powerful new techniques may permit
researchers to identify and measure the specific contribution
of each gene to the complex behaviors associated with heavy drinking.
This research will provide the basis for new medications to treat
alcohol-related problems.
• Treatment: NIAAA-supported researchers
have made considerable progress in evaluating commonly used therapies
and in developing new types of therapies to treat alcohol-related
problems. One large-scale study sponsored by NIAAA found that
each of three commonly used behavioral treatments for alcohol
abuse and alcoholism—motivation enhancement therapy, cognitive-behavioral
therapy, and 12-step facilitation therapy—significantly
reduced drinking in the year following treatment. This study also
found that approximately one-third of the study participants who
were followed up either were still abstinent or were drinking
without serious problems 3 years after the study ended. Other
therapies that have been evaluated and found effective in reducing
alcohol problems include brief intervention for alcohol abusers
(individuals who are not dependent on alcohol) and behavioral
marital therapy for married alcohol-dependent individuals.
• Medications development: NIAAA has made developing
medications to treat alcoholism a high priority. We believe that
a range of new medications will be developed based on the results
of genetic and neuroscience research. In fact, neuroscience research
has already led to studies of one medication—naltrexone
(ReVia™)—as an anticraving medication.
NIAAA-supported researchers found that this drug, in combination
with behavioral therapy, was effective in treating alcoholism.
Naltrexone, which targets the brain’s reward circuits, is
the first medication approved to help maintain sobriety after
detoxification from alcohol since the approval of disulfiram (Antabuse®)
in 1949. The use of acamprosate, an anticraving medication that
is widely used in Europe, is based on neuroscience research. Researchers
believe that acamprosate works on different brain circuits to
ease the physical discomfort that occurs when an alcoholic stops
drinking. Acamprosate should be approved for use in the United
States in the near future, and other medications are being studied
as well.
• Combined medications/behavioral therapies:
NIAAA-supported researchers have found that available medications
work best with behavioral therapy. Thus, NIAAA has initiated a
large-scale clinical trial to determine which of the currently
available medications and which behavioral therapies work best
together. Naltrexone and acamprosate will each be tested separately
with different behavioral therapies. These medications will also
be used together to determine if there is some interaction between
the two that makes the combination more effective than the use
of either one alone.
In
addition to these efforts, NIAAA is sponsoring promising research
in other vital areas, such as fetal alcohol syndrome, alcohol’s
effects on the brain and other organs, aspects of drinkers’
environments that may contribute to alcohol abuse and alcoholism,
strategies to reduce alcohol-related problems, and new treatment
techniques. Together, these investigations will help prevent alcohol
problems; identify alcohol abuse and alcoholism at earlier stages;
and make available new, more effective treatment approaches for
individuals and families.
Resources
For
more information on alcohol abuse and alcoholism, contact the
following organizations:
Al-Anon Family Group Headquarters, Inc.
1600 Corporate Landing Parkway
Virginia Beach, VA 23454–5617
Phone: (757) 563–1600; Fax: (757) 563–1655
Email: WSO@al-anon.org
Internet address: http://www.al-anon.alateen.org
Makes
referrals to local Al-Anon groups, which are support groups for
spouses and other significant adults in an alcoholic person’s
life. Also makes referrals to Alateen groups, which offer support
to children of alcoholics. Free informational materials and locations
of Al-Anon or Alateen meetings worldwide can be obtained by calling
the toll-free number (888) 425–2666 from the United States
or Canada, Monday through Friday, 8 a.m.–6 p.m. (e.s.t.).
Alcoholics Anonymous (AA) World Services, Inc.
475 Riverside Drive, 11th Floor
New York, NY 10115
Phone: (212) 870–3400; Fax: (212) 870–3003
Email: via AA’s Web site
Internet address: http://www.aa.org
Makes
referrals to local AA groups and provides informational materials
on the AA program. Many cities and towns also have a local AA
office listed in the telephone book. All communication should
be directed to AA’s mailing address: AA World Services,
Inc., Grand Central Station, P.O. Box 459, New York, NY 10163.
National Council on Alcoholism and Drug Dependence, Inc. (NCADD)
20 Exchange Place, Suite 2902
New York, NY 10005
Phone: (212) 269–7797; Fax: (212) 269–7510
Email: national@ncadd.org
HOPE LINE: (800) NCA–CALL (24-hour Affiliate referral)
Internet address: http://www.ncadd.org
Offers
educational materials and information on alcoholism. Provides
phone numbers of local NCADD Affiliates (who can provide information
on local treatment resources) via the above toll-free, 24-hour
HOPE LINE.
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
5635 Fishers Lane, MSC 9304
Bethesda, MD 20892-9304
Phone: (301) 443–3860; Fax: (301) 480–1726
Email: niaaaweb-r@exchange.nih.gov
Internet address: http://www.niaaa.nih.gov
Makes
available free informational materials on all aspects of alcoholism,
including the effects of drinking during pregnancy, alcohol use
and the elderly, and help for cutting down on drinking.
NIH Publication
No. 96–4153
Revised 2001
|