Casual drinking is a common ritual in our culture -- from campus keg parties, to a "beer and a dog" at the ballgame, to a nice bottle of wine on the dinner table. In countless advertisements, fun-loving youth frolic on the beach with beer cans in hand: To drink is to be happy, the tantalizing ads promise. But while it's hard to deny the pleasures of a gin and tonic on a lazy summer evening, for millions of Americans drinking is the root of a nightmarish disease. For alcoholics, behind the glamor of crystal snifters and decorative ice buckets looms an addiction that causes more than 100,000 deaths every year.
What is alcoholism?
Alcoholism, also called "alcohol dependence," is a chronic, progressive disease marked by a high tolerance for alcohol and a physical dependence on it. Contrary to what many people believe, alcoholics aren't people with weak moral character or a lack of will power. Rather, alcoholism is an illness, one that affects more than 7 million Americans.
How does alcoholism differ from alcohol abuse?
The two disorders have many symptoms in common, so the line between them is often tough to draw. However, most experts say the element of physical dependence is not found in alcohol abusers, who are also less likely to have the high tolerance for drink found in alcoholics. Alcohol abusers may progress to becoming alcoholics, but not necessarily.
What causes alcoholism?
No one really knows, but experts do agree that the disease's development is influenced by many forces: hereditary, social, psychological, and environmental.
Today, many researchers believe that most of the harmful effects seen in alcoholics are caused by a buildup of a toxic metabolic byproduct of alcohol called acetaldehyde. This substance may interact with brain chemicals to create a physiological need for the alcoholic to continue drinking, scientists believe. It may also cause cell damage in many organs.
Curiously, a strong tolerance for alcohol may predict the development of alcoholism later in life. Young men who can "drink others under the table," for example, have a higher risk of becoming alcoholics than their peers who cannot. One theory is that young men with a high early tolerance have a neurochemical deficiency that allows them to drink more alcohol before feeling its intoxicating effects. This way, the disease can sneak up on them before they realize what's happening.
Are some people more apt to become alcoholics than others?
Yes. Studies show that children of alcoholics are much more prone to alcoholism, probably due to both nature and nurture, a combination of genetic factors, and the impact of growing up in an alcoholic home. Alcoholics are two to three times as likely to be male as female. Finally, some studies show that people who begin drinking at a very young age have a much higher rate of alcoholism than others -- in one study, 40 percent of the people who started drinking before the age of 15 later became dependent on alcohol.
How do I know if I'm an alcoholic?
The following symptoms should tip you off that you -- or someone you know -- may need treatment for alcoholism:
- An uncontrollable craving. An actual need for alcohol may seem unfathomable to someone who's not an alcoholic, but if you're alcoholic, you have a craving for alcohol similar to that of food and water.
- No such thing as "one or two." Alcoholics can't just have a drink or two. You may have good intentions, but once you start, you have to keep drinking.
- "Eye openers." Needing a drink first thing in the morning is a sign of alcoholism.
- Drinking for one. Drinking in secret (and hiding the evidence) is another indicator.
- High tolerance. An alcoholic can drink an extraordinary number of drinks and still appear to function relatively normally.
- Needing more and more. An alcoholic often ends up needing increasing amounts in order to achieve the "high."
- Drinking dominates everyday life. When drinking is doing significant harm to your work, school, or home responsibilities on a regular basis, and you still can't control it or cut back, you are likely suffering from alcoholism. If you've read the memoir Angela's Ashes by Frank McCourt, you'll recognize this behavior in the painful portrayal of the author's father, who routinely and maddeningly drinks away the family's food money despite the obvious love he has for his wife and children.
- Withdrawal symptoms. If you regularly experience nausea, sweating, shakiness, or anxiety when you stop after a period of heavy drinking, you are physically dependent on alcohol.
What are the consequences of alcoholism?
Social costs. Studies show that problem drinking increases the incidence of domestic violence and job loss, as well as the likelihood of serious conflict with partners, children, and friends. The risk of automobile crashes skyrockets, and drownings, on-the-job accidents, homicide, and suicide are all higher for alcoholics.
Serious health problems for the drinker:
- Alcoholic hepatitis. This disease involves a liver inflammation that can even lead to death if heavy drinking continues. Hepatitis of any kind causes characteristic yellowish color in the eyes and skin and leads to liver dysfunction, fever and abdominal pain. If you're able to quit, the symptoms may vanish altogether.
- Cirrhosis of the liver. Cirrhosis is an actual scarring of the liver developed by 10 to 20 percent of alcoholics. The disease is irreversible, and if you can't stop drinking, cirrhosis may eventually require you to have a liver transplant. This condition can also lead to death. Telltale signs may include red lines on the face and in other areas, caused by tiny, broken blood vessels. Digestive tract problems.
- Heavy drinking may cause stomach ulcers and pancreatitis, an inflammation of the pancreas.
- Increased risk of certain cancers. Cancer of the liver, esophagus, throat, and larynx (voice box) are more likely among heavy drinkers.
- Central nervous system disorders. Short-term memory loss and even dementia may occur in late-stage alcoholics.
- Brain damage. A study at the University of California, San Diego shows that binge drinking during the developmental stage of ages 15 to 16 may damage teenagers' ability to think, putting them at a disadvantage in school and in finding a job. And a University of Oklahoma Health Sciences Center study found that just four years of heavy drinking (at least 10 drinks a day) can cause significant mental decline.
- Fetal Alcohol Syndrome (FAS). Heavy drinking while pregnant can cause severe and irreversible birth defects, including FAS, one of the the leading known causes of mental retardation. Even light drinking during pregnancy may cause learning difficulties in your offspring. Federal health agencies recommend that women avoid alcohol entirely while pregnant and nursing.
How is alcoholism treated?
There are some researchers who believe alcoholics can learn to drink "normally." However, most experts believe that total abstinence for life is the only way alcoholics can recover and avoid relapse, and that is the goal of most successful treatment programs. Treatment usually begins with an initial period of detoxification (getting alcohol out of the system safely), followed by counseling, a nutrition program, and sometimes prescription medicines to help prevent relapse.
Treating alcoholism is a long and difficult process, and few people can weather it on their own. Your doctor and/or the National Council on Alcoholism and Drug Dependence (NCADD) can help you find treatment programs and support groups in your area.
Alcoholics Anonymous, the best-known program, offers a 12-step path to recovery that focuses on getting alcoholics to admit that their drinking is a problem and that they need to stop. The AA program has a slightly religious bent that encourages alcoholics to rely on a "higher power" to help them stop drinking, and suggests that they spread AA's message as a means of atoning for the harm they've caused themselves and others. Other recovery approaches, such as Rational Recovery and Secular Organizations for Sobriety (see links below), offer similar programs.
With the help of such programs, millions of alcoholics have gone on to lead healthy lives free of alcohol.
Are any medications useful in treating alcoholism?
Yes. While drug treatment alone is not likely to help an alcoholic, drugs used alongside a behavioral program may indeed improve chances for recovery. These drugs have been approved for the treatment of alcoholism in the US:
Disulfiram, or Antabuse, makes drinking unpleasant by causing nausea, vomiting, and throbbing headaches when combined with alcohol.
Naltrexone, or ReVia, helps some alcoholics keep cravings in check. Vivitrol, an injectable version of naltrexone, was approved by the FDA in 2006. Since it only requires a monthly shot, it may be easier for people to use consistently.
Acamprosate or Campral, which the FDA approved to treat alcoholism in 2004, may act on the brain pathways associated with alcohol abuse to help someone who has quit drinking avoid alcohol in the future.
Also, Valium (diazepam) and other sedatives may be prescribed in order to ease anxiety during the struggle to stay on the wagon.
What can I do if I think a loved one is an alcoholic?
If you or your loved one have symptoms such as those described above, alcoholism may be to blame. Organizations like Alcoholics Anonymous have quizzes on their Web sites designed to tell you whether you might be an alcoholic. To be sure, however, you should discuss the issue with your doctor.
Many alcoholics do not want help and often deny that they have a problem. In this case, family members can seek professional help with counselors to plan an "intervention," a group confrontation to urge the loved one to accept treatment for his or her problem.
If you think that a loved one is an alcoholic, seek help as soon as possible through your doctor or one of the groups listed below. Do not attempt to talk to your friend or relative about the problem when they are drinking, and try to avoid blaming them when you do talk about it. Also, seek support for yourself through a group such as Al-Anon, which helps families and friends of alcoholics (see below).
Where can I get help and/or more information about alcoholism?
The National Council on Alcoholism and Drug Dependence (NCADD) is an independent volunteer organization that provides free information and referrals for counseling and support. Call 800/622-2255, a 24-hour "hope line," to be referred to a local NCADD affiliate.
244 East 58 Street, Fourth Floor, New York, NY 10022
Alcoholics Anonymous (AA) has over 100,000 chapters worldwide. Check their Web site or your local phone book, or call 212/870-3400 to find a group near you.
P.O. Box 459
Grand Central Station
New York, NY, 10163
Secular Organizations for Sobriety (SOS) provides support groups and information for people who are dependent on alcohol and/or drugs and want to become sober.
SOS National Clearinghouse
4773 Hollywood Blvd.
Hollywood, CA 90027
Rational Recovery Systems also provides nonreligious support for people who want to achieve sobriety.
Lotus, CA, 95651
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is a public institute within the US Department of Health and Human Services. Their Web site features links to the latest research, government publications and answers to frequently asked questions about alcohol and alcohol abuse.
5635 Fishers Lane, MSC 9304
Bethesda, Maryland 20892
Al-Anon and Alateen (for teenagers) provide support programs for families and friends of alcoholics using the same approach as Alcoholics Anonymous. Check their Web site or your local phone book, or call 888/425-2666 to find a group near you.
Al-Anon Family Groups Headquarters, Inc.
Corporate Landing Parkway
Virginia Beach, VA, 23454
Mayo Clinic. Alcoholism: Treatments and Drugs. May 2008. http://mayoclinic.com
Schuckit, M. Men more than twice as likely as women to develop alcohol dependence. The Lancet. January 23, 2009.
Eriksson CJ. The role of acetaldehyde in the actions of alcohol (update 2000). Alcohol Clin Exp Res 2001 May;25(5 Suppl ISBRA)
Jacob T, Windle M. Young adult children of alcoholic, depressed and nondistressed parents. J Stud Alcohol 2000 Nov;61(6):836-44
DJ, Adlaf EM, Offord DR, Ogborne AC. Age at first alcohol use: a risk factor for the development of alcohol disorders. Am J Psychiatry 2000 May;157(5):745-50
FDA Approves New Drug for Treatment of Alcoholism. FDA Talk Paper. July 29, 2004. http://www.fda.gov
Institute on Alcohol Abuse and Alcoholism. Twelve-month prevalence and population estimates of DSM IV alcohol dependence by age, sex, and race-ethnicity: United States, 2001-2002 (NESARC). January 2005. http://www.niaaa.nih.gov