Alcoholism

Alcoholism (AL-ko-ha-li-zum) is a disease in which people crave alcohol and keep drinking even though it causes repeated problems in many parts of a person's life.

Jennifer had her first glass of champagne at a family wedding when she was 11. By the time she was 13, she was drinking beer with her friends on Saturday nights. At 15, she was locking herself in her room and drinking alone during the week, when she was supposed to be getting ready for school or doing her homework. At first, drinking seemed like an exciting thing to do. Before long, though, it became something she had to do just to get through the day. Jennifer was not old enough to get a driver's license, but she was already alcohol-dependent.

What Is Alcoholism?

Although many people do not think of it as one, alcohol is a drug. Alcoholism, also known as alcohol dependence, is really a drug addiction (a-DIK-shun), in which people have a strong craving to keep using alcohol even though it causes repeated problems at home, school, or work. The key traits of alcoholism are:

• craving: a strong need to drink
• loss of control: the inability to limit drinking
• tolerance: the need for ever-increasing amounts of alcohol in order to feel its effects
• withdrawal: physical symptoms that occur when alcohol use is stopped after a period of drinking.

Alcoholism has little to do with what kind of alcohol people drink, how long they have been drinking, or even how much they drink. What is important is the person's uncontrollable need for alcohol. This explains why it can be so hard for people with alcoholism to stop drinking, even if they try. They may feel the need for alcohol as strongly as other people feel the need for food and water. Although some people are able to break the grip of this powerful craving on their own, most need help to do so.

What Is Alcohol Abuse?

Alcohol abuse, like alcoholism, refers to an unhealthy pattern of alcohol use that leads to frequent, serious problems. Unlike alcoholism, it does not involve an extremely strong craving, a loss of control, or the physical signs of tolerance and withdrawal. In some ways, then, alcohol abuse is a less severe problem, but it still can have very serious effects. The key traits of alcohol abuse are:

• failing to meet responsibilities at home, school, or work, for example, neglecting chores at home or skipping classes due to drinking
• drinking in situations that are physically dangerous, for example, just before or while driving a car
• getting into alcohol-related trouble with the law, for example, being arrested for underage drinking, disorderly conduct, or DUI (driving under the influence)
• continuing to drink despite relationship problems that are caused or made worse by alcohol, for example, getting into arguments with parents or physical fights with friends or siblings.

Alcohol abuse can follow different patterns. Some people are binge drinkers, which means they drink only on certain days, such as on the weekend, when they have five or more drinks at one time. Binge drinkers often have accidents that hurt themselves or others or do things while drunk that they later regret. They also may go on to become heavy drinkers, which means they drink at this level on five or more days per month. Heavy drinkers, in turn, may go on to experience full-fledged alcoholism.

What Are the Short-Term Risks?

Alcohol dulls the senses, slows reaction time ^* , decreases coordination, and impairs judgment. It is little wonder that alcohol use is a major risk factor for accidents and injuries. Car crashes are the leading cause of death in 15- to 20-year-olds, and two of every five traffic deaths in this age group involve alcohol. Overall, people with alcoholism are nearly 5 times more likely than average to die in car crashes, 10 times more likely to be hurt in fires, and 16 times more likely to die in falls.

Alcohol robs people of their ability to think clearly. As a result, people are more likely to have unplanned sex when they have been drinking. This puts them at higher risk of unwanted pregnancy or sexually transmitted disease ^* . In addition, some boys still believe that it is okay to force a girl to have sex if she is drunk. As a result, girls who drink may run a greater risk of being raped by someone they know. Alcohol is involved in many cases of date rape.

What Are the Long-Term Risks?

Alcoholism not only disrupts people's lives but also destroys their health. Long-term, heavy drinking affects almost every organ in the body. The physical risks of alcoholism include:

• Liver ^* disease: More than 2 million Americans have an alcoholrelated liver disease. Alcoholic hepatitis (he-pa-TY-tis) is inflammation of the liver, while alcoholic cirrhosis (si-RO-sis) is scarring of the liver. Alcohol-related liver disease can cause chronic illness and death.
• Heart disease: Long-term, heavy drinking raises the risk of high blood pressure, heart disease, and some kinds of stroke.
• Cancer: Long-term, heavy drinking also increases the risk of cancer of the mouth, throat, esophagus ^* , larynx ^* , stomach, pancreas ^* , liver, and possibly the colon ^* and rectum ^* . In addition, women who have two or more drinks per day have a slightly higher than average risk of breast cancer.
• Pancreas disease: Pancreatitis (pan-kree-a-TY-tis) is inflammation of the pancreas. It can cause severe abdominal pain, weight loss, and death.
• Mental disorders: Long-term, heavy use of alcohol can cause or worsen several mental disorders, especially depression and anxiety disorders.

Alcohol also can interfere with the body's ability to absorb and use vitamins, especially the B vitamins. A lack of enough vitamins can damage the brain and cause problems with thought and memory. In severe cases, it can lead to Wernicke-Korsakoff (VER-ni-kee-KOR-sa-kof) syndrome, in which the ability to learn new information is seriously harmed.

Students at a fraternity party crowd around a pitcher of beer. Binge drinking, or having several drinks in a row for the purpose of getting drunk, has become a growing problem on college campuses. Its effects can be serious, including alcohol poisoning, coma, and even death.

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How Are Women Affected?

Women get drunk more easily than men, even when differences in body weight are taken into account. This is because women's bodies contain less water per pound than men's bodies. Since alcohol mixes with body water, alcohol is closer to its full, undiluted strength in women than in men.

Women who drink during pregnancy can have children with a wide range of physical, mental, and behavioral problems. Fetal alcohol syndrome (FAS) is the most severe set of birth defects caused by alcohol. Children with FAS may have problems with eating, sleeping, vision, and hearing. They also may grow poorly and have birth defects of the heart, kidneys, skeleton, and other parts of the body. As children with FAS get older, they may have trouble following directions, learning to do simple things, and paying attention in school. They also may find it hard to get along with others and control their behavior. Since no one knows exactly how much alcohol it takes to cause birth defects, it is best not to drink any alcohol at all during pregnancy.

How Are Families Affected?

Living with or caring about a person with alcoholism can be very stressful. This is especially true for the 11 million children under age 18 in the United States who have an alcoholic parent. Alcohol use can lead to frequent arguments in the home, and it plays a role in the breakup of many marriages. In addition, alcohol use is a factor in more than half of all cases of family violence. It is not surprising that children of alcoholic parents are more likely to show signs of depression, anxiety, and low self-esteem than are other children. As they get older, they may have trouble in school, and they may tend to score lower on tests that measure verbal skills. They also may be more likely to have alcohol and drug problems of their own.

This does not mean that all children of alcoholic parents are doomed, however. Many do well and thrive, particularly if they have positive relationships with other people, such as friends in school, social groups, or at church, synagogue, or mosque. Support groups for family members and friends, such as Al-Anon and Alateen, also can help people learn to cope with someone else's drinking.

What Causes Alcoholism?

Millions of adults drink alcohol occasionally without any trouble. Yet as many as 1 in every 13 adults in the United States goes on to abuse alcohol or become alcohol-dependent. Alcohol problems are more common in men than in women, and they occur most often in young adults ages 18 through 29. Yet anyone of any age and either sex can be affected.

Many young people first start drinking as a way to escape their problems, feel accepted, or feel better about themselves. Those youngsters who move on to frequent or heavy drinking are more likely to be depressed, have low self-esteem, or feel as if they do not fit in. Pressure from friends and easy access to alcohol may make it more likely that drinking will get out of hand. Alcoholism also may tend to run in families. Children of alcoholic parents can be at risk for several reasons. They often live in stress-filled homes where heavy drinking might be seen as normal. In addition, the genetic ^* makeup of these children may raise their risk of alcoholism.

What Are the Signs of Alcoholism?

Warning signs include:

• Being preoccupied with drinking: People with alcoholism generally are always thinking about their next drink.
• Viewing alcohol as a cure-all: People with alcoholism may drink to steady their nerves, treat a hangover, or "fix" almost any problem.
• Needing to drink increasing amounts to feel high: People with alcoholism often must drink ever-increasing amounts to get the desired effect.
• Losing control over drinking: Although they may try, people with alcoholism typically cannot limit themselves to one or two drinks.
• Drinking alone: Social drinkers enjoy the company of others. People who are alcohol-dependent enjoy the alcohol itself.
• Needing to drink to feel normal: People with alcoholism usually feel as if they must drink just to cope with their everyday lives.
• Feeling guilty and making excuses: People with alcoholism often blame their drinking on other people or on outside events.
• Having blackouts: People with alcoholism may be unable to remember what happened while they were drinking, which is sometimes called "alcohol amnesia."

How Is Alcoholism Treated?

Alcoholism is a treatable disease. Treatment often begins with detoxification, the process of safely getting all the alcohol out of a person's body. During the first days after drinking is stopped, people may be given medication by a physician to replace the alcohol and then gradually be weaned off the medication over a period of about a week. The goal is to reduce withdrawal symptoms and restore good health. Rest, a balanced diet, and plenty of fluids also are stressed.

Medications

Once detoxification is complete, some people take medications to help prevent a return to drinking. Disulfiram (dy-SUL-fi-ram; Antabuse) can help deter alcohol use by causing several unpleasant symptoms when a person drinks alcohol, including severe nausea, vomiting, hot flushing, headache, and anxiety. Naltrexone (nal-TREK-zone; Re Via) is another medication that sometimes is given to people with alcoholism. Scientists think it may block the craving for more that these people usually feel after taking a first drink.

Therapy

Various kinds of therapy are used to treat alcoholism. Therapy can help people identify the feelings and situations that trigger their drinking. It also can help them find new ways to cope that do not involve using alcohol. Therapy can be provided individually or in a group, and it can take place in a mental health center or a hospital. Social skills training teaches people to handle social situations better. Behavioral therapy helps people learn to control harmful behavior and the impulse to drink. Family therapy focuses on problems at home that may play a role in alcohol use, such as drinking by family members.

Self-help groups

Most treatment programs include meetings of Alcoholics Anonymous or other self-help groups. People who take part in such groups get help and support from others who have faced the same problems. Membership is open to anyone with a desire to stop drinking. Alcoholics Anonymous has more than 50,000 groups with more than 1 million members in the United States alone.

How Well Does Treatment Work?

Alcoholism can be a tough addiction to beat, but treatment can be very helpful. Studies have shown that 7 of 10 alcohol-dependent people who get treatment have stopped or cut back on their drinking and improved their health within 6 months. The goal of treatment is to quit drinking entirely, but most people have at least one or two slips before they reach this goal. Such slips are common, and they do not mean that people have failed. They just mean that people must stop drinking again and get whatever help they need to give up the habit. The longer people go without drinking, the more likely it is that they will stay sober for good.