Alcoholism

Alcohol addiction is a disease with consequences reaching far beyond the health of the drinker. Alcoholism has a huge impact on an individual’s loved ones, coworkers, and even strangers who are at risk of harm from violence or accidents caused by an intoxicated person. Unfortunately, alcoholism is also one of the most common psychiatric disorders, affecting up to 14 percent of the population.[8] Below, we discuss the signs and symptoms that differentiate alcoholism from normal drinking as well as various treatments for the disease.

Definition of Alcoholism

Alcoholism is a physical and psychological dependence on alcohol that usually involves periods of frequent and heavy drinking and drinking despite problems resulting from alcohol use.

Signs & Symptoms of Alcoholism

The most obvious sign of alcoholism is frequent, heavy drinking.[8] Blackouts, slurred speech, trouble walking straight, memory loss, and sexual dysfunction are related symptoms of alcoholism.[8] Mood changes including mood swings, depression, and anxiety can also indicate a problem as can insomnia, chronic fatigue, and digestive problems.[8] Visible physical symptoms include weight loss, jaundice (yellowing of the skin and eyes), and red nose and cheeks.[1,8] People addicted to alcohol may also experience withdrawal symptoms including nausea, anxiety, sweating, tremors, or even hallucinations when they try to stop drinking.[1,4]

Some indirect signs of alcoholism to look out for are problems at work and school (including excessive absences), drinking in risky situations such as before driving, trouble controlling how much alcohol you drink, trying to mask how much you drink, drinking in the morning or when alone, feelings of guilt about drinking, and having other people worry about how much you are drinking.[1]

However, the line between problem drinking and alcoholism is sometimes difficult to see. It is also possible to have an unhealthy relationship with alcohol without meeting the criteria for alcoholism.

Alcohol abuse is any pattern of drinking that has a negative effect on your relationships, health, or work/school. Alcohol abuse can lead to many of the same results as alcoholism including work problems, putting yourself or others in danger, and damaging relationships. It is a serious disorder in its own right and over time, people who abuse alcohol may become alcoholic.[2,4]

Binge drinking is a type of alcohol abuse that results in bringing the blood alcohol level to above 0.08 percent, the equivalent of about 4 drinks for women or about 5 drinks for men over the course of two hours.[2] Binge drinking is unhealthy, leading to health risks including injuries, car accidents, and alcohol poisoning. In the long run, binge drinking can also cause liver damage and other problems.[2]

Alcoholism is different from binge drinking and non-alcoholic alcohol abuse because it is a chronic (continuing) dependence. Unlike people who binge drink or abuse alcohol but are not alcoholics, alcoholics require alcohol to function and cannot easily stay sober for long periods of time.

Critically, alcoholism includes the following symptoms not found in binge drinking and alcohol abuse:

  • Strong cravings for alcohol
  • Losing control over how much you drink
  • Increased tolerance for alcohol (needing more and more to achieve the same effect)
  • Withdrawal symptoms such as anxiety, nausea or sweating when stopping drinking[4]

Although it cannot diagnose alcoholism, AUDIT, the Alcohol Use Disorders Identification Test (http://whqlibdoc.who.int/hq/(3)001/who_msd_msb_01.7.pdf), provides a useful starting point for evaluating how your drinking habits affect your relationships and health.

Causes of Alcoholism

Although some people continue to believe stress causes alcoholism, it is simply not true. Alcoholics may deal with stress by drinking more, but a difficult job, problematic relationship, or a traumatic upbringing is not to blame for excessive drinking.

Although the causes of alcoholism are complex and are not completely understood, we know that genes play an important role. People with alcoholism in their families have a much higher risk of becoming alcoholic.[6,8,9] Studies have suggested that people who inherit genes that contribute to alcoholism may have brains that respond differently to drinking, making it harder to stop drinking or increasing cravings for it.[5] Excessive drinking combined with this susceptibility may lead to alcoholism.

Having this genetic predisposition does not mean someone will necessarily become an alcoholic, however. Environment, personality traits, and other risk factors outlined below interact with genes and affect the likelihood that a predisposed person will develop an addiction to alcohol.

Risk Factors for Alcoholism

Because a predisposition for alcoholism is inherited, the most significant risk factor for alcoholism is family history.[6,8,6] This is especially true if you have an alcoholic parent.[8] Other risks for alcoholism include age (the earlier a person begins drinking, the more likely they are to become alcoholic), being male, smoking, and existing psychiatric problems (including depression, anxiety, post-traumatic stress disorder, and bipolar disorder).[6,9] Living in a culture where alcohol is easily obtained and socially acceptable also increases alcoholism risk, as do personality traits such as impulsiveness, aggression, and high self-expectations.[9] Native Americans have higher rates of alcoholism, while Jewish and Asian Americans have lower rates.[6]

Effects of Alcoholism

The physical effects of alcohol increase the longer alcohol abuse occurs. The long-term effects of alcoholism can include brain shrinkage, gastrointestinal problems, heart damage, nerve damage, and thiamine deficiency leading to brain disorders.[1] Liver disease is also a common effect of alcoholism. Cirrhosis, the final and often irreversible stage of liver disease, can result in a number of complications including jaundice, fatigue, weakness, and a dangerous brain disorder called hepatic encephalopathy.[2,3] In pregnant women, alcohol use can also lead to Fetal Alcohol Syndrome, a collection of symptoms affecting babies including mental retardation and unusual facial features.[1]

Treatment for Alcoholism

Abstinence–stopping drinking entirely–is the ultimate goal of alcohol treatment.

Treatment for alcoholism focuses on three areas: physical dependence, psychological dependence, and habit and may take several forms.[8] The first part of recovery from alcoholism deals with physical dependence. Because withdrawal symptoms can include seizures, heart problems, and suicidal behaviors, chronic alcoholics may need to be hospitalized during detoxification.[8]

Even after detoxification, alcoholics tend to keep craving alcohol due to changes alcohol causes in the brain, making them prone to relapse.[8] Recovering alcoholics are especially vulnerable when facing depression, anxiety, and other stressors.[5,6] This is true even after years of sobriety.[5] The second part of recovery focuses on helping alcoholics understand and predict these cravings and learn skills for dealing with them.[8] Behavioral treatments include cognitive behavioral therapy (CBT), support groups and 12-step programs such as Alcoholics Anonymous, and other types of counseling.

Medications for alcoholism are also being developed. These include medications aimed at reducing cravings for alcohol, such as naltrexone (Revia), those that block the brain’s reward system for alcohol (Acamprosate), and those that cause unpleasant reactions when someone drinks alcohol, such as disulfiram (Antabuse).[6,8]

References

  1. Alcohol Abuse and Dependence – Symptoms.WebMD. Retrieved from http://www.webmd.com/mental-health/alcohol-abuse/alcohol-abuse-and-dependence-symptoms
  2. Alcohol and Public Health: Frequently Asked Questions.Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/alcohol/faqs.htm
  3. Alcohol’s Damaging Effects on the Brain.National Institutes of Health. Retrieved from http://pubs.niaaa.nih.gov/publications/aa63/aa63.htm
  4. Alcohol Use Disorders.National Institute on Alcohol Abuse and Alcoholism. Retrieved fromhttp://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders
  5. Alcoholism and Alcohol Abuse: Causes.The New York Times Health Guide. Retrieved from http://health.nytimes.com/health/guides/disease/alcoholism/causes.html
  6. Alcoholism and Alcohol Abuse: Risk Factors.The New York Times Health Guide. Retrieved fromhttp://health.nytimes.com/health/guides/disease/alcoholism/risk-factors.html
  7. New Leads On the Causes of Alcoholism.ScienceDaily. Retrieved from http://www.sciencedaily.com/releases/2011/04/110404161829.htm
  8. Problem drinking and alcoholism: Diagnosis and treatment.American Family Physician. Retrieved from http://www.aafp.org/afp/2002/0201/p441.html
  9. Risk Factors for Alcohol Abuse and Alcoholism.Aurora Health Care. Retrieved from http://www.aurorahealthcare.org/yourhealth/healthgate/getcontent.asp?URLhealthgate=%2219041.html%22

By C. J. Newton, MA, Counseling.info Editor

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