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.
Alcohol consumption more severely affects women than men, according to a coordinated study carried out by researchers at RTI International, Pavlov Medical University, Leningrad Regional Center of Addictions, Pacific Institute for Research and Evaluation, and Johns Hopkins School of Medicine.
A Canadian study found that alcohol is a factor in 1 in 25 deaths worldwide. The British Medical Association says that alcohol kills six people in Scotland every day.
The lifetime risk of alcohol-use disorders for men is more than 20%, with a risk of about 15% for alcohol abuse and 10% for alcohol dependence, according to researchers from the University of California, San Diego, USA.
Alcohol consumption, when in moderation can have some positive effects on health. Moderate red wine drinking has several health benefits. Researchers at the University of Illinois found that injured patients with alcohol in their blood have a smaller chance of dying in hospital. The researchers said that their findings should not encourage people to drink.
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.
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?
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.
How is alcoholism diagnosed?In the USA a person must meet the criteria laid out in the DSM (Diagnostic and Statistical Manual of Mental Disorders), published by the APA (American Psychiatric Association). This includes a pattern of alcohol abuse which leads to considerable impairment or distress. The patient should experience at least three of the criteria below during the past 12 months:
- Alcohol tolerance - the patient needs a large quantity of alcohol to feel intoxicated. However, when the liver is damaged and cannot metabolize the alcohol so well, this tolerance may drop. Damage to the central nervous system may also reduce tolerance levels.
- Withdrawal symptoms - when the patient abstains from alcohol or cuts down he/she experiences tremors, insomnia, nausea or anxiety. Typically, the patient drinks more to avoid these symptoms.
- Beyond intentions - the patient ends up drinking more alcohol, or drinks for a longer period than he/she intended.
- Unsuccessfully attempting to cut down - the patient is continuously trying to cut down alcohol consumption, but does not succeed. Or the patient has a persistent desire to cut down.
- Time consuming - the patient spends a lot of time obtaining, using or recovering from alcohol consumption.
- Withdrawal - the patient withdraws from recreational, social, or occupational activities. This did not used to be the case.
- Persistence - the patient carries on consuming alcohol even though he/she knows it is harming him/her physically and psychologically.
Blood tests can only reveal very recent alcohol consumption. They cannot tell whether a person has been drinking heavily for a long time.
If a blood test reveals that the red blood cells have increased in size it could be an indication of long-term alcohol abuse.
Carbohydrate-deficient transferrin (CDT) - this is a test which helps detect heavy alcohol consumption. It is a blood test.
There are other tests which can indicate whether the liver has been damaged, or whether a man has reduced testosterone levels - however, screening with a good questionnaire is seen as the most effective means for an accurate diagnosis.
Most alcoholics deny they have a problem and tend to minimize the extent of their drinking. Talking to family members may help the doctor in his/her diagnosis (permission will be needed for this).
Complications of alcoholism and alcohol abuseUsually, drinking alcohol initially elevates the person's mood. However, after a long period of regular heavy drinking the person's nervous system will become depressed and the drinker will become sedated by alcohol. Alcohol may undermine a person's judgment; it can lower inhibitions and alter the drinker's thoughts, emotions and general behavior. Heavy regular drinking can have a serious effect on a person's ability to coordinate his/her muscles and speak properly. Heavy binge drinking could cause the patient to go into coma.
Eventually, regular heavy drinking may cause at least one of the following problems:
- Fatigue - the patient is tired most of the time.
- Memory loss - especially the patient's short-term memory.
- Eye muscles - the eye muscles can become significantly weaker.
- Liver diseases - the patient has a considerably higher chance of developing hepatitis, and cirrhosis. Cirrhosis of the liver is an irreversible and progressive condition.
- Gastrointestinal complications - the patient can develop gastritis, or pancreas damage. These problems also seriously undermine the body's ability to digest food, absorb certain vitamins, and produce hormones which regulate metabolism.
- Hypertension - regular heavy drinking invariably raises the person's blood pressure.
- Heart problems - regular heaving drinking can lead to cardiomyopathy (damaged heart muscle), heart failure, and stroke.
- Diabetes - alcoholics have a very high risk of developing diabetes type 2. Patients who have diabetes will invariably have serious complications if they are regular heavy drinkers of alcohol. Alcohol prevents the release of glucose from the liver, causing hypoglycemia. A person with diabetes is already taking insulin to lower his/her blood sugar levels - hypoglycemia could be devastating.
- Menstruation - alcoholism will usually stop menstruation or disrupt it.
- Erectile dysfunction - alcoholic men are much more likely to have problems getting an erection, or sustaining one.
- Fetal alcohol syndrome - women who abuse alcohol during their pregnancy are much more likely to have babies with birth defects, including a small head, heart problems, shortened eyelids, as well as developmental and cognitive problems.
- Thinning bones - alcoholics invariably suffer from thinning of the bones because alcohol interferes with the production of new bone. This means an increased risk of fractures.
- Nervous system problems - alcoholism often causes numbness in the extremities, dementia and confused/disordered thinking.
- Cancer - alcoholics have a much higher risk of developing several cancers, including cancer of the mouth, esophagus, liver, colon, rectum, breast, prostate and pharynx.
An international study found that the key causes of bowel cancer are alcohol and smoking.
In fact, even moderate alcohol consumption is linked to a higher incidence of cancer among women, a study found. Another study found that consuming just two or more drinks per day could increase a person's risk of pancreatic cancer by about 22%.
- Accidents - alcoholics are vulnerable to injuries from falls, car crashes, being run over, etc. The NIH says that over half of all American traffic deaths are alcohol-related.
- Domestic abuse - alcohol is a major factor in spouse beating, child abuse, and conflicts with neighbors.
- Work (school) problems - employment problems, unemployment, school problems, are often alcohol-related.
- Suicide - suicide rates among people who are alcohol-dependent or who abuse alcohol are much higher than among other people.
- Mental illness - alcohol abuse can cause mental illness and make existing mental illnesses worse.
- Problems with the law - the percentage of alcoholics who end up in court or in prison is significantly higher compared to the rest of the population.
Treatment for alcohol dependencySome medical inpatients with unhealthy alcohol use may benefit from a brief intervention, say researchers from Boston University School of Medicine.
The first step for the alcoholic is to acknowledge that there is an alcohol dependency problem. The next step is to get help. In most of the world there are several support groups and professional services available.
A study found that people with a stable psychosocial life situation often delay in seeking help for their alcohol problems even though they are serious.
In another study, published in March 2012, scientists from Norway re-analyzed data from old trials that tested LSD (lysergic acid diethylamide) for the treatment of alcoholism and concluded that a single dose of the psychedelic drug was effective in decreasing alcohol misuse.
Researchers from the Center for Imaging of Neurodegenerative Diseases, San Francisco VA Medical Center, San Francisco, informed in Frontiers in Pharmacology in October 2012 that veterans who smoke have a higher risk of alcohol abuse relapse than non-smokers. They added that smoking while trying to give up drinking impairs memory, learning and other cognitive skills, which undermine successful sobriety.
The following are recognised treatment options for alcoholism:
- Do-it-yourself - experts say about 30% of people with an alcohol problem manage to reduce their drinking or abstain without seeking professional help. There is a great deal of material in books and the internet that may help the self-helper.
- Counseling - a qualified counselor can help the alcoholic talk through his/her problems and then devise a plan to tackle the drinking. CBT (cognitive behavioral therapy) is commonly used to treat alcohol dependency.
- Treating underlying problems - the alcoholic may have a problem with self-esteem, stress, anxiety, depression, or some other mental health problem. It is important to treat these problems too. It is crucial for the alcoholic to realize that drinking will probably make mental health problems worse. As alcoholics commonly suffer from hypertension, liver diseases, and possibly heart diseases, these will need to be treated too.
- Residential programs - residential programs are ideal for some people. They include expert professional help, individual or group therapy, support groups, training, family involvement, activity therapy, and a host of strategies that are aimed at treating the alcoholic successfully. Some people find that being physically away from access to temptation is a great help.
- Drug that provokes a severe reaction to alcohol - Antabuse (disulfiram) causes a severe reaction when somebody drinks alcohol, including nausea, flushing, vomiting and headaches. It is a deterrent. It will not treat the alcoholic's compulsion and will not cure alcoholism.
- Drugs for cravings - Naltrexone (ReVia) may help with the urge to have a drink. Acamprosate (Campral) may help with cravings.
- Hormone ghrelin - Researchers at the Sahlgrenska Academy, Gothenburg, have discovered a new brain mechanism involved in alcohol addiction involving the stomach hormone ghrelin. When ghrelin's actions in the brain are blocked, alcohol's effects on the reward system are reduced. It is an important discovery that could lead to new therapies for addictions such as alcohol dependence.
- Detoxification - the patient takes some medication to prevent withdrawal symptoms (delirium tremens) which many alcoholics experience when they give up drinking. Treatment usually lasts from four to seven days. Chlordiazepoxide, a benzodiazepine medication, is frequently used for detoxification (detox). Doses will be initially high, and will then taper off. It is important that the patient abstains completely from alcohol during the detox.
- Staying on the wagon (remaining abstinent) - some patients find the detox acheivable, but start drinking again soon after, or some time later. It is important to remember Samuel Johnson's phrase, "If at first you don't succeed. Try, try, and try again." Success rates are significantly improved if the patient has access to counseling or some support group. Family support is crucial. Sometimes a good GP can provide vital support. A study found that genetics is a factor in predicting the risk of relapse among alcohol-dependent patients.
Written by Christian Nordqvist