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Alcoholism, also known as alcohol
dependence, is a disease that includes the following four symptoms:
Craving--A strong need, or urge, to drink.
Loss of control--Not being able to stop drinking once drinking has
begun.
Physical dependence--Withdrawal symptoms, such as nausea, sweating,
shakiness, and anxiety after stopping drinking.
Tolerance--The need to drink greater amounts of alcohol to get
"high."
For clinical and research purposes, formal diagnostic criteria for
alcoholism also have been developed. Such criteria are included in
the Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition, published by the American Psychiatric
Association, as well as in the International Classification
Diseases, published by the World Health Organization. (See also
"Publications," Alcohol Alert No. 30: Diagnostic Criteria for
Alcohol Abuse and Dependence.)
Yes, alcoholism is a disease. The
craving that an alcoholic feels for alcohol can be as strong as the
need for food or water. An alcoholic will continue to drink despite
serious family, health, or legal problems.
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. (See also "Publications," Alcohol Alert No. 30:
Diagnostic Criteria for Alcohol Abuse and Dependence.)
Research shows that the risk for
developing alcoholism does indeed run in families. The genes a
person inherits partially explain this pattern, but lifestyle is
also a factor. Currently, researchers are working to discover the
actual genes that
put people at risk for alcoholism. Your friends, the amount of
stress in your life, and how readily available alcohol is also are
factors that may increase your risk for alcoholism.
But remember: Risk is not destiny. Just because alcoholism tends to
run in families doesn't mean that a child of an alcoholic parent
will automatically become an alcoholic too. Some people develop
alcoholism even though no one in their family has a drinking
problem. By the same token, not all children of alcoholic families
get into trouble with alcohol. Knowing you are at risk is important,
though, because then you can take steps to protect yourself from
developing problems with alcohol. (See also "Publications," A Family
History of Alcoholism - Are You at Risk?; Alcohol Alert No. 18: The
Genetics of Alcoholism.)
No, alcoholism cannot be cured at
this time. Even if an alcoholic hasn't been drinking for a long
time, he or she can still suffer a relapse. Not drinking is the
safest course for most people with alcoholism.
Yes, alcoholism can be treated.
Alcoholism treatment programs use both counseling and medications to
help a person stop drinking. Treatment has helped many people stop
drinking and rebuild their lives. (See also "Publication," Alcohol
Alert No. 49: New Advances in Alcoholism Treatment.)
Three oral medications--disulfiram (Antabuse®),
naltrexone (Depade®, ReVia®), and acamprosate (Campral®)--are
currently approved to treat alcohol dependence. In addition, an
injectable, long-acting form of naltrexone (Vivitrol®) is available.
These medications have been shown to help people with dependence
reduce their drinking, avoid relapse to heavy drinking, and achieve
and maintain abstinence. Naltrexone acts in the brain to reduce
craving for alcohol after someone has stopped drinking. Acamprosate
is thought to work by reducing symptoms that follow lengthy
abstinence, such as anxiety and insomnia. Disulfiram discourages
drinking by making the person taking it feel sick after drinking
alcohol.
Other types of drugs are available to help manage symptoms of
withdrawal (such as shakiness, nausea, and sweating) if they occur
after someone with alcohol dependence stops drinking.
Although medications are available to 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. (See also "News
Releases," Jan. 17, 1995: Naltrexone Approved for Alcoholism
Treatment and "Publication," Alcohol Alert No. 61: Neuroscience
Research and Therapeutic Targets.)
Alcoholism treatment works for many
people. But like other chronic illnesses, such as diabetes, high
blood pressure, and asthma, 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.
No. Alcoholism is only one type of an
alcohol problem. Alcohol abuse can be just as harmful. A person can
abuse alcohol without actually being an alcoholic--that is, he or
she may drink too much and too often but still not be dependent on
alcohol. Some of the problems linked to alcohol abuse include not
being able to meet work, school, or family responsibilities;
drunk-driving arrests and car crashes; and drinking-related medical
conditions. Under some circumstances,
even social or moderate drinking is dangerous--for example, when
driving, during pregnancy, or when taking certain medications.
Alcohol abuse and alcoholism cut
across gender, race, and nationality. In the United States, 17.6
million people--about l in every 12 adults--abuse alcohol or are
alcohol dependent. In general, 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--are at much higher risk of
developing alcohol problems at some point in their lives compared to
someone who starts drinking at age 21 or after. (See also "News
Releases," June 10, 2004 "Alcohol Abuse Increases, Dependence
Declines Across Decade: Young Adult Minorities Emerge As High-Risk
Subgroups" and July 3, 2006 "Early Drinking Linked to Higher
Lifetime Alcoholism Risk. See also Alcohol Alert No. 55: Alcohol and
Minorities: An Update.)
Answering the following four
questions can help you find out if you or a loved one has a drinking
problem:
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?
One "yes" answer suggests a possible alcohol problem. More than one
"yes" answer means it is highly likely that a problem exists. If you
think that you or someone you know might have an alcohol problem, it
is important to see a doctor or other health care provider right
away. They can help you determine if a drinking problem exists and
plan the best course of action.
It depends. If that person has been
diagnosed as an alcoholic, the answer is "no." Alcoholics who try to
cut down on drinking rarely succeed. Cutting out alcohol--that is,
abstaining--is usually the best course for recovery. People who are
not alcohol
dependent but who have experienced alcohol-related problems may be
able to limit the amount they drink. If they can't stay within those
limits, they need to stop drinking altogether. (See the question 13,
"What is a safe level of drinking?") (See
also "Publications/Pamphlets and Brochures," How to Cut Down on Your
Drinking.)
This can be a challenge. An alcoholic
can't be forced to get help except under certain circumstances, such
as a traffic violation dor arrest that results in court-ordered
treatment. 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 who 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, and 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 care of themselves, regardless of whether the
alcoholic family member chooses to get help. (See the question 19,
"How can a person get help for an alcohol problem" for referral to
support groups.)
For most adults, moderate alcohol
use--up to two drinks per day for men and one drink per day for
women and older people-- causes few if any problems. (One drink
equals one 12-ounce bottle of beer or wine cooler, one 5-ounce glass
of wine, or 1.5 ounces of 80-proof distilled spirits.)
Certain people should not drink at all, however:
Women who are pregnant or trying to become pregnant
People who plan to drive or engage in other activities that require
alertness and skill (such as driving a car)
People taking certain over-the-counter or prescription medications
People with medical conditions that can be made worse by drinking
Recovering alcoholics
People younger than age 21.
(See also "Publications" Harmful Interactions: Mixing Alcohol With
Medicines and Drinking and Your Pregnancy; Alcohol Alert
No. 27: Alcohol-Medication Interactions; Alcohol Alert No 50: Fetal
Alcohol Exposure and the Brain; and Alcohol Alert No. 52:
Alcohol and Transportation Safety)
No, alcohol can harm the baby of a
mother who drinks during pregnancy. Although the highest risk is to
babies whose mothers drink heavily, it is not clear yet whether
there is any completely safe level of alcohol during pregnancy. For
this reason, the U.S. Surgeon General released advisories in 1981
and again in 2005 urging women who are pregnant or may become
pregnant to abstain from alcohol (http://www.lhvpn.net/hhspress.html).
The damage caused by prenatal alcohol includes a range of physical,
behavioral, and learning problems in babies Babies most severely
affected have what is called Fetal Alcohol Syndrome (FAS). These
babies may have abnormal facial features and severe learning
disabilities. Babies can also be born with mild disabilities without
the facial changes typical of FAS.
(See also "Publications" Alcohol Alert No.50: Fetal Alcohol Syndrome
and the Brain; "Pamphlets and Brochures," Drinking and Your
Pregnancy.)
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. (See the question 18, "When taking
medications, must you stop drinking?" for more information.) In
addition, alcohol can make many of the medical conditions common in
older people, including high blood pressure and ulcers, more
serious. Physical changes associated with aging can make older
people feel "high" even after drinking only small amounts of
alcohol. So even if there is no medical reason to avoid alcohol,
older men and women should limit themselves to one drink per day.
(See also "Publications/Pamphlets and Brochures" Age Page: Alcohol
Use and Abuse.)
Yes, 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. (See the question 13, "What is a safe level of
drinking?" for recommended limits.)
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. (See also "Publications," Alcohol Alert No. 62:
Alcohol-An Important Women's Health Issue.)
Studies have shown that moderate
drinkers are less likely to die from one form of heart disease than
are people who do not drink any alcohol or who drink more.
If you are a nondrinker, however, you should not start drinking
solely to benefit your heart. You can guard against heart disease by
exercising and eating foods that are low in fat. And if you are
pregnant, planning to become pregnant, have been diagnosed as
alcoholic, or have another medical condition that could make alcohol
use harmful, you should not drink.
If you can safely drink alcohol and you choose to drink, do so in
moderation. Heavy drinking can actually increase the risk of heart
failure, stroke, and high blood pressure, as well as cause many
other medical problems, such as liver cirrhosis.
(See also "Publications," Alcohol Alert No. 16: Moderate Drinking
and Alcohol Alert No. 45: Alcohol Coronary Heart Disease.)
Possibly. More than 150 medications
interact harmfully with alcohol. These interactions may result in
increased risk of illness, injury, and even death. Alcohol's effects
are heightened by medicines that depress the central nervous system,
such as sleeping pills, antihistamines, antidepressants,
anti-anxiety drugs, and some painkillers. In addition, medicines for
certain disorders, including diabetes, high blood pressure, and
heart disease, can have harmful interactions with alcohol. If you
are taking any over-the-counter or prescription medications, ask
your doctor or pharmacist if you can safely drink alcohol. (See also
"Publications," Harmful Interactions; Mixing Alcohol with Medicines;
Alcohol Alert No. 27: Alcohol-
Medication Interactions.)
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