Alcoholism and Alcohol Abuse

Also known as: Alcohol dependence
What is it?
Alcoholism is a disorder that is characterized by an excessive dependence upon and craving for alcoholic beverages. This dependence affects every aspect of the alcoholic’s life - socially, personally, and professionally – and can lead to physical and psychological harm to the alcoholic and often to those around him or her. Many people consider alcoholism and alcohol abuse to be the same. However, a person who abuses alcohol does not crave alcohol or become dependent on it. The alcohol abuser has a pattern of excessive drinking that results in poor judgment and recurring social, legal, or professional consequences of the abuse. Prolonged alcohol abuse often leads to alcoholism.
Who gets it?
Anyone who drinks alcohol can fall into the trap of alcoholism. However, people who have a family history of alcohol abuse disorders are more likely to also have this disorder. Men are more likely to become alcoholics than women. Adolescents are at higher risk for alcohol abuse because of the tendency to binge drink.
What causes it?
Many factors can contribute to alcoholism and alcohol abuse. These can include depression, a disruptive home life, peer pressure, and job problems. Those with a family history of alcoholism may have a genetically inherited lower sensitivity to alcohol, which means they can drink more without feeling the effects. It is difficult to separate the effects of environment and heredity as a cause of alcoholism.
What are the symptoms?
Alcoholics have an uncontrollable craving for alcohol. While they may recognize that their use of alcohol is self-destructive and hurts others, they are unable to resist the compulsion to drink and are unable to control the amount of alcohol they drink at one time. With time, alcoholics need to drink more and more to feel good because they develop a tolerance for alcohol. An alcoholic who suddenly stops drinking will develop withdrawal symptoms, similar to a drug addict. These might include weakness, tremors, sweating, and nausea. More serious withdrawal symptoms include seizures, hallucinations, and delirium tremens (DTs). The DTs is a severe onset of anxiousness, confusion, and delirium, accompanied by high fever, that can be fatal if untreated. Untreated alcoholism can damage just about every organ in the body. Complications of alcoholism can include liver damage (cirrhosis), brain damage, heart failure, persistent tremor, depression, malnutrition, stomach ulcers, high blood pressure, decreased sex drive, bleeding in the esophagus, and certain cancers, particularly of the throat, liver, pancreas, and esophagus. Many alcoholics have a thiamine deficiency, which can cause Korsakoff’s and Wernicke’s syndromes.
With Korsakoff’s, the patient cannot remember recent events. Wernicke’s is characterized by a loss of coordination and abnormal eye movements. Abusing alcohol can also result in nausea, vomiting, diarrhea, memory loss, slurred speech, and difficulty with coordination. Pregnant women who drink are more likely to have children with birth defects (fetal alcohol syndrome), and drunken drivers are more likely to cause accidents that may result in death. Alcoholics are also more likely to commit suicide, or physically harm another person. People who abuse alcohol, but are not alcoholics, drink to the point where their good judgment is impaired. These people usually have a pattern of letting drinking interfere with personal or professional responsibilities, binge drinking, or drinking and driving. These patterns are also true of alcoholics.
How is it diagnosed?
Doctors define moderate alcohol use as up to two drinks per day for men and one drink per day for women and the elderly. To diagnose alcoholism or alcohol abuse, your doctor will ask you about your drinking habits. How often do you drink? How many drinks do you have per day or week? How do you feel if you don’t drink? Do you drink in the morning to relieve a hangover? The doctor will want to know why and when you are more likely to drink, if you have felt guilty about your drinking, if you ever experience withdrawal symptoms as a result of not drinking alcohol, if you find yourself choosing to drink over other activities, and if your drinking has had an effect on your job performance and personal relationships, or has resulted in legal problems. The doctor will take your medical history and perform a physical examination. He or she may order blood tests.
What is the treatment?
Someone who is an alcoholic or abuses alcohol regularly must stop drinking all together. There is no cure for alcoholism that allows the patient to drink socially without relapses into old habits. Successful treatment requires behavioral therapy and a strong support system. Because of this, treatment programs must have family participation, if possible. During treatment, your doctor will monitor your progress. Treatment begins with detoxification, which is a medically supervised program to rid the body of the toxic effects of the alcohol. Detoxification results in mild to severe withdrawals symptoms. Patients suffering severe withdrawal symptoms may be treated in a hospital setting with sedative medications to help relieve symptoms and intravenous (IV) fluids to replace those lost through nausea and vomiting. These fluids often include essential nutrients, such as thiamine, that are typically low in alcoholics. Detoxification is followed by rehabilitation, which helps restore the patient’s physical and mental health. Most alcoholics benefit from a program, such as Alcoholics Anonymous, that provides peer support and step-by-step guidance for abstaining from alcohol. Some patients take a prescription drug, such as disulfiram, which causes extremely unpleasant side effects if combined with alcohol, or naltrexone, which helps curb alcohol craving. People who are not alcoholics, but abuse alcohol, are also treated with behavioral therapy to help them examine the reasons they drink, face the consequences of their drinking, and find ways to avoid those situations.
Self-care tips
People who are diagnosed alcoholics or alcohol abusers face a life-long recovery process. While it is not uncommon to experience a relapse, it is important to seek the support you need to continue to be alcohol-free. Because teenagers are in the highest risk group for alcohol abuse, it is extremely important for parents to educate their children about the dangers of alcohol consumption and provide a model of healthy behavior in terms of alcohol use.