According to Alcoholics Anonymous UK, who say they have no unique definition for alcoholism, it may be described as a physical compulsion, together with a mental obsession. Apart from having an enormous craving for alcohol, an alcoholic often yields to that craving at the worst possible times. The alcoholic knows neither when nor how to stop drinking.
Definition - an alcoholic is a person, while alcoholism is the illness. An alcoholic suffers from alcoholism. Alcoholism is a long-term (chronic) disease.
Alcoholics are obsessed with alcohol and cannot control how much they consume, even if it is causing serious problems at home, work, and financially.
Alcohol abuse generally refers to people who do not display the characteristics of alcoholism, but still have a problem with it - they are not as dependent on alcohol as an alcoholic is; they have not yet completely lost their control over its consumption.
Moderate alcohol consumption will not generally cause any psychological or physical harm. However, for some individuals, social drinking eventually leads to heavier and heavier alcohol consumption, which does cause serious health and psychological problems.
Alcoholism in the UK - one in every 13 people in the United Kingdom is an alcoholic, according to the NHS (National Health Service) statistics. Even among people who are not dependent on alcohol, a sizeable proportion drink too much.
In the USA, 15% of Americans are problem drinkers, while between 5% to 10% of male and 3% to 5% of female drinkers could be diagnosed as alcohol dependent, according to the National Institutes of Health (NIH).
The World Health Organization (WHO) says there are at least 140 million alcoholics in the world; unfortunately, the majority of them are not treated.
A US study estimated that about 30% of Americans report having an alcohol disorder at some time in their lives. Meanwhile, a Canadian study found that alcohol is a factor in 1 in 25 deaths worldwide.
What are the symptoms of alcoholism?
The signs of alcoholism and alcohol abuse are very similar, and are often just a question of degree or intensity.
Typically, the last person to be aware that he/she has a serious drinking problem is the alcoholic himself/herself - they are in denial.
Some signs and symptoms of alcoholism, as well as alcohol abuse, include:
- Drinking alone.
- Drinking in secret.
- Not being able to limit how much alcohol is consumed.
- Blacking out - not being able to remember chunks of time.
- Having rituals and being irritated/annoyed when these rituals are disturbed or commented on. This could be drinks before/during/after meals, or after work.
- Dropping hobbies and activities the person used to enjoy; losing interest in them.
- Feeling an urge to drink.
- Feeling irritable when drinking times approach. This feeling is more intense if the alcohol is not available, or there appears to be a chance it may not be available.
- Having stashes of alcohol in unlikely places.
- Gulping drinks down in order to get drunk and then feel good.
- Having relationship problems (triggered by drinking).
- Having problems with the law (caused by drinking).
- Having work problems (caused by drinking, or drinking as root cause).
- Having money problems (caused by drinking).
- Requiring a larger quantity of alcohol to feel its effect.
- Nausea, sweating, or even shaking when not drinking.
A person who abuses alcohol may have many of these signs and symptoms - but they do not have the withdrawal symptoms like an alcoholic does, nor the same degree of compulsion to drink.
The problems linked to alcohol dependence are extensive, and affect the person physically, psychologically and socially. Drinking becomes a compulsion for a person with a drink problem - it takes precedence over all other activities. It can remain undetected for several years.
What is binge drinking?
In the UK, binge drinking occurs when a man consumes more than eight units of alcohol and a woman consumes over six units in one sitting. Drinking large amounts of alcohol now-and-again is worse for the heath than frequently drinking small quantities.
Binge drinking has become a growing problem in many countries, especially in the UK where 40% of emergency hospital admittances are alcohol-related. Sipping wine, beer or spirits three to four times per week increases the risk of binge drinking, particularly among young men, according to a study carried out by researchers from the Université de Montréal and the University of Western Ontario.
Men who drink 22 or more units of alcohol a week have a 20% higher rate of admissions into acute care hospitals than non-drinkers, researchers from the University of Glasgow found.
Binge drinking among college students and heart disease - researchers from the University of Illinois at Chicago reported in the Journal of the American College of Cardiology that healthy young adults who regularly binge drink may have a higher risk of heart disease later in life.
Senior author, Shane A. Phillips and team found that college binge drinkers show damage to blood vessels similar to that caused by high cholesterol and hypertension, both factors linked to heart disease.
Phillips said "Regular binge drinking is one of the most serious public health problems confronting our college campuses, and drinking on college campuses has become more pervasive and destructive. Binge drinking is neurotoxic and our data support that there may be serious cardiovascular consequences in young adults."
What causes alcoholism (alcohol dependence)?
Alcohol dependence is a gradual process which can take from a few years to several decades to become a problem - with some very vulnerable people addiction can come in a question of months. Eventually, over time, regular alcohol consumption can disrupt the balance of the brain chemical GABA (gamma-aminobutyric acid), which controls impulsiveness, as well as glutamate, which stimulates the nervous system.
Brain levels of dopamine are raised when we consume alcohol - dopamine levels may make the drinking experience more gratifying. Over the long- or medium-term, excessive drinking can significantly alter the levels of these brain chemicals, making the person's body crave alcohol in order to feel good and avoid feeling bad.
These risk factors may also be linked to excessive drinking:
- Genes - scientists say there are specific genetic factors which may make some people more likely to become addicted to alcohol, as well as other substances. People who have a family history of addiction are at higher risk for abusing alcohol. Alcoholics are six times more likely than nonalcoholic to have blood relatives who are alcohol dependent. Researchers from the Universidad de Granada, Spain, revealed that "the lack of endorphin is hereditary, and thus that there is a genetic predisposition to become addicted to alcohol".
- The age of first alcoholic drink - a study found that people who started drinking alcohol before the age of 15 were much more likely to have an alcohol problem later in life.
- Underage drinking in the USA is common - 26.6% of Americans under the legal age for alcohol consumption are drinking, a new report issued by SAMHSA (Substance Abuse and Mental Health Services) informed in a new report.
The authors explained that although some progress had been made in the short term to reduce underage drinking, especially among children aged up to 17 years, underage drinking rates are still excessively high in the USA.
Of the 12-20 year olds who said they had drunk alcohol during the previous four weeks, 8.7% had bought it themselves.
Pamela S. Hyde, an AMHSA Administrator, said:
"Underage drinking should not be a normal part of growing up. It's a serious and persistent public health problem that puts our young people and our communities in danger. Even though drinking is often glamorized, the truth is that underage drinking can lead to poor academic performance, sexual assault, injury, and even death."
- Smoking, especially non-daily smokers - A study by Yale University researchers found that non-daily smokers are five times more likely to have a problem with alcohol compared to people who have never smoked.
- Easy access - Experts say there is a correlation between easy access to alcohol (cheap prices) and alcohol abuse and alcohol-related deaths. A US study found a strong link between alcohol tax increases in 1983 and 2002 and a significant drop in deaths related to alcohol use in one American state - the effect was found to be nearly two to four times that of other prevention strategies such as school programs or media campaigns.
- Stress - some stress hormones are linked to alcoholism. If our levels of stress, anxiety are high some of us may consume alcohol in an attempt to blank out the upheaval. Military service members returning from Iraq and Afghanistan are likely to experience posttraumatic stress disorder and alcohol use disorders simultaneously, according to researchers at the National Institute on Alcohol Abuse and Alcoholism.
- Peer drinking - people who have friends who drink regularly or abuse alcohol are more likely to drink excessively and eventually have an alcohol problem.
- Low self-esteem - experts say that people with low self-esteem who have alcohol readily available are more likely to abuse it.
- Depression - people with depression may deliberately or unwittingly use alcohol as a means of self-treatment. On the other hand, a statistical modeling study suggested that alcohol abuse may lead to depression risk, rather than vice versa.
- Media and advertising - in some countries alcohol is portrayed as a glamorous, worldly and cool activity. Many experts believe that alcohol advertising and media coverage of it may convey the message that excessive drinking is acceptable. The Royal College of Physicians is asking for a European Union ban on alcohol advertising to protect children.
- How the body processes (metabolizes) alcohol - people who need comparatively more alcohol to achieve an effect have a higher risk of eventually having an alcohol problem, a study carried out by researchers at the University of California, San Diego, found.
On the next page we look at how alcoholism is diagnosed, the complications of alcohol abuse and treatments for alcohol dependency.