Alcoholism

Alcoholism Overview

Alcohol problems vary in severity from mild to life threatening and affect the individual, the person's family, and society in numerous adverse ways. Despite all of the focus on drugs such as cocaine, alcohol remains the number one drug problem in the United States. According to community surveys, over 13% of adults in the United States will experience alcohol abuse or dependence (also referred to as alcoholism) at some point in their lives.

Withdrawal, for those physically dependent on alcohol, is much more dangerous than withdrawal from heroin or other narcotic drugs.

• Alcohol abuse refers to excessive or problematic use with one or more of the following:
  • Failure to fulfill major obligations at work, school, or home
  • Recurrent use in situations where it is hazardous (such as driving a car or operating machinery)
  • Legal problems
  • Continued use of alcohol despite having social, family, or interpersonal problems caused by or worsened by drinking
• Alcohol dependence refers to a more serious disorder and involves excessive or maladaptive use leading to 3 or more of the following:
  • Tolerance changes (need for more to achieve desired effect, or achieving the effect with lesser amounts of alcohol)
  • Withdrawal symptoms following a reduction or cessation of drinking (such as sweating, rapid pulse, tremors, insomnia, nausea, vomiting, hallucinations, agitation, anxiety, or seizures) or using alcohol to avoid withdrawal symptoms (for example, early morning drinking)
  • Drinking more alcohol or drinking over a longer period of time than intended (loss of control)
  • Inability to cut down or stop
  • Spending a great deal of time drinking or recovering from its effects
  • Giving up important social, occupational, or recreational activities
  • Continuing to drink despite knowing alcohol use has caused or worsened problems

Alcoholism Causes

The cause of alcoholism is not well established. There is growing evidence for genetic and biologic predispositions for this disease, but this research is controversial. Studies examining adopted children have shown that children of alcoholic biological parents have an increased risk of becoming alcoholics. Relatively recent research has implicated a gene (D2 dopamine receptor gene) that, when inherited in a specific form, might increase a person's chance of developing alcoholism. Twice as many men are alcoholics. And 10-23% of alcohol-consuming individuals are considered alcoholics.

Usually, a variety of factors contribute to the development of a problem with alcohol. Social factors such as the influence of family, peers, and society, and the availability of alcohol, and psychological factors such as elevated levels of stress, inadequate coping mechanisms, and reinforcement of alcohol use from other drinkers can contribute to alcoholism. Also, the factors contributing to initial alcohol use may vary from those maintaining it, once the disease develops.

Alcoholism Symptoms

Alcoholism is a disease. It is often diagnosed more through behaviors and adverse effects on functioning than by specific medical symptoms. Only 2 of the diagnostic criteria are physiological (those are tolerance changes and withdrawal symptoms).

• Alcohol abuse and alcoholism are associated with a broad range of medical, psychiatric, social, legal, occupational, economic, and family problems. For example, parental alcoholism underlies many family problems such as divorce, spouse abuse, child abuse and neglect, welfare dependence, and criminal behaviors, according to government sources.
  • The great majority of alcoholics go unrecognized by physicians and health care professionals. This is largely because of the alcoholic’s ability to conceal the amount and frequency of drinking, denial of problems caused by or made worse by drinking, the gradual onset of the disease, and the body's ability to adapt to increasing alcohol amounts.
  • Family members often deny or minimize alcohol problems and unwittingly contribute to the continuation of alcoholism by well-meaning behaviors such as shielding the alcoholic from adverse consequences of drinking or taking over family or economic responsibilities. Often the drinking behavior is concealed from loved ones and health care providers.
  • Alcoholics, when confronted, will often deny excess consumption of alcohol. Alcoholism is a diverse disease and is often influenced by the alcoholic's personality as well as by other factors. Therefore, signs and symptoms often vary from person to person. There are, however, certain behaviors and signs that indicate someone may have a problem with alcohol. These behaviors and signs include insomnia, frequent falls, bruises of different ages, blackouts, chronic depression, anxiety, irritability, tardiness or absence at work or school, loss of employment, divorce or separation, financial difficulties, frequent intoxicated appearance or behavior, weight loss, or frequent automobile collisions.
  • Late signs and symptoms include medical conditions such as pancreatitis, gastritis, cirrhosis, neuropathy, anemia, cerebellar atrophy, alcoholic cardiomyopathy (heart disease), Wernicke's encephalopathy (abnormal brain functioning), Korsakoff's dementia, central pontine myelinolysis (brain degeneration), seizures, confusion, malnutrition, hallucinations, peptic ulcers, and gastrointestinal bleeding.
• Compared with children in families without alcoholism, children of alcoholics are at increased risk for alcohol abuse, drug abuse, conduct problems, anxiety disorders, and mood disorders. Alcoholic individuals have a higher risk of psychiatric disorders and suicide. They often experience guilt, shame, and depression, especially when their alcohol use leads to significant losses (for example, job, relationships, status, economic security, or physical health). Many medical problems are caused by or made worse by alcoholism as well as by the alcoholic’s poor adherence to medical treatment.

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Reviewed: 01/2006

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