According to the National Institute of Health (NIH), in 2015, 15.1 million American adults (6.2 percent of the population) had an alcohol use problem.
According to the World Health Organization (WHO), globally, 3.3 million deaths every year result from harmful use of alcohol.
Alcoholism is a term for long-term addiction to alcohol.
Alcoholics Anonymous U.K., do not have a formal definition for alcoholism, but say it may be described as a physical compulsion, together with a mental obsession. They say that, apart from having an enormous craving for alcohol, an alcoholic often gives in to the 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. It should also be acknowledged that there is a growing trend away from using the term "alcoholic" as it is perceived to be a negative label. Instead, you may hear the person referred to as "a person who suffers from alcohol use disorder."
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.
Typically, the last person to be aware that they have a serious drinking problem is the person with alcohol use disorder - they are often in denial.
Some signs and symptoms 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 quicker 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.
There are many potential causes for alcoholism, including peer pressure to drink, drinking from a young age, and depression.
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 number 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 may be specific genetic factors that make some people more likely to become addicted to alcohol, and other substances. People who have a family history of addiction are at higher risk for abusing alcohol.
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.
- Easy access - experts say there is a correlation between easy access to alcohol (cheap prices) and alcohol abuse and alcohol-related deaths. A U.S. 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 and anxiety are high, some of us may consume alcohol in an attempt to blank out the upheaval.
- 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, 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.
- 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.
In the U.S., to be diagnosed as an alcoholic, the individual 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 that 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, they experience 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 they 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 they know it is harming them physically and psychologically.
Some signs and symptoms of alcohol abuse may be due to another condition, or simple aging, such as memory problems, or falling. Some patients may go to their doctor about a medical condition, such as a digestive problem, and not mention their alcohol abuse.
It is not always easy for a doctor to identify candidates for alcohol dependency screening. If a doctor suspects alcohol may be a problem, they may ask a series of questions - if the patient answers in a certain way, the doctor may go on to use a standardized questionnaire.
Tests for alcoholism
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 that can indicate whether the liver has been damaged, or whether a man has reduced testosterone levels, both of which might indicate chronic alcohol consumption; 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 understand the situation (permission will be needed for this).
Complications of alcoholism may include memory loss, confusion, mental illness, and problems with work or home life.
Usually, 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 their 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 that regulate metabolism.
- Hypertension - regular heavy drinking invariably raises the person's blood pressure.
- Heart problems - regular heavy 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 their 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 or sustaining an erection.
- 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 can cause 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.
- Accidents - alcoholics are vulnerable to injuries from falls, car crashes, being run over, etc.
- 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 higher than among people who do not.
- Mental illness - alcohol abuse increases the risk of mental illness and can 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 with the rest of the population.
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 countries there are a range of support groups and professional services available.
The following are recognized treatment options for alcoholism:
- Do-it-yourself - some 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 on the Internet that may help the self-helper.
- Counseling - a qualified counselor can help the alcoholic talk through their 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; but 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.
- Detoxification - the patient takes some medication to prevent withdrawal symptoms (delirium tremens), which many alcoholics experience when they give up drinking. Treatment usually lasts 4-7 days. Chlordiazepoxide, a benzodiazepine medication, is frequently used for detoxification (detox).
- Staying on the wagon (remaining abstinent) - some patients find the detox achievable, but start drinking again soon after, or some time later. 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.
- Alcoholics Anonymous - Alcoholics Anonymous is an international fellowship of men and women who have had a drinking problem. It is nonprofessional, self-supporting, multiracial, apolitical, and available almost everywhere. There are no age or education requirements. Membership is open to anyone who wants to stop drinking and solve their drinking problem.