Alcohol Abuse

Definition

Alcoholism or alcohol dependence is a chronic disease, characterized by the consumption of alcohol beverages at a level that interferes with physical and mental health and with family and social responsibilities. An alcoholic will continue to drink despite serious health, family or legal problems. Alcoholism is the most severe form of alcohol abuse.

Like many other diseases, alcoholism is chronic, meaning that it lasts a person’s lifetime; it usually follows a predictable course; and it has symptoms. The risk for developing alcoholism is influenced both by a person’s genes and by his or her lifestyle.

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
     

  • Continued drinking despite having ongoing relationship problems that are caused or worsened by the drinking

    Although alcohol abuse is basically different from alcoholism, alcoholics also experience many effects of alcohol abuse.

    Alcohol abuse and alcoholism cut across gender, race, and nationality. Nearly 14 million people in the United States - 1 in every 13 adults - abuse alcohol or are alcoholic. In general, though, more men than women are alcohol dependent or have alcohol problems. And alcohol problems are highest among young adults ages 18-29 and lowest among adults ages 65 and older. We also know that people who start drinking at an early age - for example, at age 14 or younger - greatly increase the chance that they will develop alcohol problems at some point in their lives.

    Alcohol’s effects do vary with age. Slower reaction times, problems with hearing and seeing, and a lower tolerance to alcohol’s effects put older people at higher risk for falls, car crashes, and other types of injuries that may result from drinking. Older people also tend to take more medicines than younger people. Mixing alcohol with over-the-counter or prescription medications can be very dangerous, even fatal. More than 150 medications interact harmfully with alcohol.

    Alcohol affects women differently than men. Women become more impaired than men do after drinking the same amount of alcohol, even when differences in body weight are taken into account. This is because women’s bodies have less water than men’s bodies. Because alcohol mixes with body water, a given amount of alcohol becomes more highly concentrated in a woman’s body than in a man’s. In other words, it would be like dropping the same amount of alcohol into a much smaller pail of water. That is why the recommended drinking limit for women is lower than for men.

    In addition, chronic alcohol abuse takes a heavier physical toll on women than on men. Alcohol dependence and related medical problems, such as brain, heart, and liver damage, progress more rapidly in women than in men.

    Symptoms
    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”.  
    • Solitary drinking  
    • Secretive about drinking behavior

    Symptoms of Alcohol Abuse

    People who abuse alcohol can identify if they have a drinking problem if they have:

       
    • Considered reducing the amount of alcohol consumed  
    • Become annoyed by criticism of drinking behavior  
    • Experienced guilt feeling about drinking behavior  
    • A drink first thing in the morning (as an “eye opener”) in order to get rid of a hangover or to steady their nerves.

    One “yes” answer suggests a possible alcohol problem. A “yes” to more than one question indicates that it is highly likely a problem exists. In either case, it is important to consult a doctor or other health care provider right away to discuss these responses. He or she can help you determine if they 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

    Side effects

       
    • Higher incidence of unemployment  
    • Higher incidence of domestic violence  
    • Legal problems

    Health hazards

       
    • Increased incidence of cancer, particularly cancer of the larynx, esophagus, liver and colon  
    • Acute and/or chronic pancreatitis  
    • Cirrhosis of the liver  
    • Alcoholic neuropathy  
    • Alcoholic cardiomyopathy  
    • High blood pressure  
    • Nutritional deficiencies  
    • High blood pressure  
    • Erectile dysfunction  
    • Cessation of menses  
    • Fetal alcohol syndrome in the children of women who drink during pregnancy  
    • Depression  
    • Traffic fatalities  
    • Accidental deaths  
    • Increased risk of suicide  
    • Wernicke-Korsakoff syndrome

    Treatment

    Alcoholism treatment programs use both counseling and medications to help a person stop drinking. Most alcoholics need help to recover from their disease. With support and treatment, many people are able to stop drinking and rebuild their lives

    Medication

    A range of medications is used to treat alcoholism. Benzodiazepines (Valiumreg;, Libriumreg;) are sometimes used during the first days after a person stops drinking to help him or her safely withdraw from alcohol. These medications are not used beyond the first few days, however, because they may be highly addictive.

    Neuroscience research has already led to studies of one medication-naltrexone (ReVia)-as an anticraving medication. This drug was effective in treating alcoholism when it was used in combination with behavioral therapy. 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 (Antabusereg;) 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.

    Through several medications help treat alcoholism; there is no “magic bullet.” In other words, no single medication is available that works in every case and/or in every person. Developing new and more effective medications to treat alcoholism remains a high priority for researchers

    Research supported by the National Institute of Alcohol Abuse and Alcoholism (NIAAA) has made considerable progress in evaluating commonly used therapies and 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.

    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.

    Seeking Help for an unwilling alcoholic

    An alcoholic can’t be forced to get help except under certain circumstances, such as a violent incident that results in court-ordered treatment or medical emergency. But you don’t have to wait for someone to “hit rock bottom” to act. Many alcoholism treatment specialists suggest the following steps to help an alcoholic get treatment:

    Stop all “cover ups.” Family members often make excuses to others or try to protect the alcoholic from the results of his or her drinking. It is important to stop covering for the alcoholic so that he or she experiences the full consequences of drinking.

    Time your intervention. The best time to talk to the drinker is shortly after an alcohol-related problem has occurred - like a serious family argument or an accident. Choose a time when he or she is sober, both of you are fairly calm, and you have a chance to talk in private.

    Be specific. Tell the family member that you are worried about his or her drinking. Use examples of the ways in which the drinking has caused problems, including the most recent incident.

    State the results. Explain to the drinker what you will do if he or she doesn’t go for help - not to punish the drinker, but to protect yourself from his or her problems. What you say may range from refusing to go with the person to any social activity where alcohol will be served, to moving out of the house. Do not make any threats you are not prepared to carry out.

    Get help. Gather information in advance about treatment options in your community. If the person is willing to get help, call immediately for an appointment with a treatment counselor. Offer to go with the family member on the first visit to a treatment program and/or an Alcoholics Anonymous meeting.

    Call on a friend. If the family member still refuses to get help, ask a friend to talk with him or her using the steps just described. A friend who is a recovering alcoholic may be particularly persuasive, but any person who is caring and nonjudgmental may help. The intervention of more than one person, more than one time, is often necessary to coax an alcoholic to seek help.

    Find strength in numbers. With the help of a health care professional, some families join with other relatives and friends to confront an alcoholic as a group. This approach should only be tried under the guidance of a health care professional that is experienced in this kind of group intervention.

    Get support. It is important to remember that you are not alone. Support groups offered in most communities include Al-Anon, which holds regular meetings for spouses and other significant adults in an alcoholic’s life, the Alateen, which is geared to children of alcoholics. These groups help family members understand that they are not responsible for an alcoholic’s drinking and that they need to take steps to take of themselves, regardless of whether the alcoholic family member chooses to get help.

    Alcoholism treatment works for many people. But just like any chronic disease, there are varying levels of success when it comes to treatment. Some people stop drinking and remain sober. Others have long periods of sobriety with bouts of relapse. And still others cannot stop drinking for any length of time. With treatment, one thing is clear, however: the longer a person abstains from alcohol, the more likely he or she will be able to stay sober.

    Johns Hopkins patient information

    Last revised: December 6, 2012
    by Simon D. Mitin, M.D.

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