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 information below will explain alcoholism and alcohol
abuse, symptoms of each, when and where to seek help, treatment choices, and
additional helpful resources.
A Widespread Problem
For most people, 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 (A standard drink is one 12-ounce bottle of
beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof
distilled spirits) -- is not harmful for most adults. Nonetheless, a substantial
number of people have serious trouble with 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 patterns that could lead to alcohol
problems. In addition, approximately 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). It 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, recreational accidents, and on-the-job accidents and
also increases the likelihood of homicide and suicide. In purely economic terms,
alcohol-use problems cost society approximately $100 billion per year. In human
terms, the costs are incalculable.
What Is Alcoholism?
Alcoholism, which is also known as "alcohol dependence
syndrome," is a disease that is characterized by the following elements:
- Craving: A strong need, or compulsion, to drink.
- Loss of control: The frequent inability to stop drinking once a person has begun.
- Physical dependence: The occurrence of withdrawal symptoms, such as
nausea, sweating, shakiness, and anxiety, when alcohol use is stopped after a
period of heavy drinking. These symptoms are usually relieved by drinking
alcohol or by taking another sedative drug.
- Tolerance: The need for increasing amounts of alcohol in order to get "high."
Alcoholism has little to do with what kind of alcohol one
drinks, how long one has been drinking, or even exactly how much alcohol one
consumes. But it has a great deal to do with a person's uncontrollable need for
alcohol. This description of alcoholism helps us understand why most alcoholics
can't just "use a little willpower" to stop drinking. He or she is frequently in
the grip of a powerful craving for alcohol, a need that can feel as strong as
the need for food or water. While some people are able to recover without help,
the majority of alcoholic individuals need outside assistance to recover from
their disease. With support and treatment, many individuals are able to stop
drinking and rebuild their lives. Many people wonder: Why can some individuals
use alcohol without problems, while others are utterly unable to control their
drinking? Recent research supported by NIAAA has demonstrated that for many
people, a vulnerability to alcoholism is inherited. Yet it is important to
recognize that aspects of a person's environment, such as peer influences and
the availability of alcohol, also are significant influences. Both inherited and
environmental influences are called "risk factors." But risk is not destiny.
Just because alcoholism tends to run in families doesn't mean that a child of an
alcoholic parent will automatically develop alcoholism.
What Is Alcohol Abuse?
Alcohol abuse differs from alcoholism in that it does not
include an extremely strong craving for alcohol, loss of control, or physical
dependence. In addition, alcohol abuse is less likely than alcoholism to include
tolerance (the need for increasing amounts of alcohol to get "high"). Alcohol
abuse is defined as a pattern of drinking that is accompanied by 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;
- 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 effects of alcohol.
While alcohol abuse is basically different from alcoholism, it
is important to note that many effects of alcohol abuse are also experienced by
alcoholics.
What Are the Signs of a Problem?
How can you tell whether you, or someone close to you, may have
a drinking problem? Answering the following four questions can help you find
out. (To help remember these questions, note that the first letter of a key word
in each of the four questions spells "CAGE.")
- 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 (Eye opener)?
One "yes" response suggests a possible alcohol problem. If you
responded "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 responses 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 for you.
Even if you answered "no" to all of the above questions, if you
are encountering drinking-related problems with your job, relationships, health,
or with the law, you should still 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
Acknowledging that help is needed for an alcohol problem may
not be easy. But keep in mind that the sooner a person gets help, the better are
his or her chances for a successful recovery.
Any reluctance you may feel about discussing your drinking with
your health care professional may stem from common misconceptions about
alcoholism and alcoholic people. In our society, the myth prevails that an
alcohol problem is somehow 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,
however, alcoholism is a disease that is no more a sign of weakness than is
asthma or diabetes. 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
experiencing 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 professional concludes that you may be dependent on alcohol, he
or she may recommend that you see a specalist in diagnosing and treating
alcoholism. You should be involved in making referral decisions and have all
treatment choices explained to you.
Getting Well
Alcoholism Treatment
The nature of treatment depends on the severity of an
individual's alcoholism and the resources that are available in his or her
community. Treatment may include detoxification (the process of safely getting
alcohol out of one's system); taking doctor-prescribed medications, such as
disulfiram (Antabuse®) or naltrexone (ReViaTM), to help prevent a
return to drinking once drinking has stopped; and individual and/or group
counseling. There are promising types of counseling that teach recovering
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. Any of these
treatments may be provided in a hospital or residential treatment setting or on
an outpatient basis.
Because the involvement 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. Some programs also link up individuals
with vital community resources, such as legal assistance, job training, child
care, and parenting classes.
Alcoholics Anonymous
Virtually all alcoholism treatment programs also include
meetings of Alcoholics Anonymous (AA), which describes itself as a "worldwide
fellowship of men and women who help each other to stay sober." While AA is
generally recognized as an effective mutual help program for recovering
alcoholics, not everyone responds to AA's style and message, and other recovery
approaches are available. Even those who are helped by AA usually find that AA
works best in combination with other elements of treatment, including counseling
and medical care.
Can Alcoholism Be Cured?
While alcoholism is a treatable disease, a cure is not yet
available. That means that even if an alcoholic has been sober for a long while
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
eventually 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 is needed 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:
- Examine the benefits of stopping an unhealthy drinking pattern.
- Set a drinking goal for yourself. Some people choose to abstain from alcohol, while 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 the support of NIAAA, scientists at medical centers and
universities throughout the country are studying alcoholism. The goal of this
research is to develop more effective 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 include:
- Genetic research: Scientists are now studying 3,000 individuals
from several hundred families with a history of alcoholism in order to
pinpoint the location of genes that influence vulnerability to alcoholism.
This new knowledge will help identify individuals at high risk for alcoholism
and also will pave the way for the development of new treatments for
alcohol-related problems. Other research is investigating the ways in which
genetic and environmental factors combine to cause alcoholism.
- Treatment approaches: NIAAA also sponsored a study called Project
MATCH, which tested whether treatment outcome could be improved by matching
patients to three types of treatment based on particular individual
characteristics. This study found that all three types of treatment reduced
drinking markedly in the year following treatment.
- New medications: Studies supported by NIAAA have led to the Food
and Drug Administration's approval of the medication naltrexone
(ReViaTM) for the treatment of alcoholism. When used in combination
with counseling, this prescription drug lessens the craving for alcohol in
many people and helps prevent a return to heavy drinking. Naltrexone is the
first medication approved in 45 years to help alcoholics stay sober after they
detoxify from alcohol.
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
to 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
1600 Corporate Landing
Parkway
Virginia Beach, VA 23454-5617
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.
Locations of Al-Anon or Alateen meetings worldwide can be obtained
by calling the toll-free numbers Monday through Friday, 8 a.m.-6 p.m.
(e.s.t.):
U. S.: (800) 344-2666
Canada: (800) 443-4525
Free informational materials can be obtained by calling the
toll-free numbers (operating 7 days a week, 24 hours per day):
U. S.: (800) 356-9996
Canada: (800) 714-7498
Alcoholics Anonymous (AA) World Services
475 Riverside
Drive, 11th Floor
New York, NY 10115
(212) 870-3400
Internet address:
http://www.alcoholics-anonymous.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.
National Council on Alcoholism and Drug Dependence
(NCADD)
12 West 21st Street
New York, NY 10010
(800)
NCA-CALL
Internet address: http://www.ncadd.org Provides phone
numbers of local NCADD affiliates (who can provide information on local
treatment resources) and educational materials on alcoholism via the above
toll-free number.
National Institute on Alcohol Abuse and
Alcoholism
Scientific Communications Branch
6000 Executive
Boulevard, Suite 409
Bethesda, MD 20892-7003
(301) 443-3860
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.
Prepared: November 1996
Ordering Information
Single copies of Alcoholism: Getting the Facts may be ordered by
writing to NIAAA or by ordering
online.
Written Request:
-
- NIAAA
- Publication Distribution Center
- P.O. Box 10686
- Rockville, MD 20849-0686
- Cost: FREE
For comments or suggestions send mail to NIAAA Web Master
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