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
Prepared: November
1996
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