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Alcohol Addiction (Alcoholism)

What Is Alcoholism?

Alcoholism is a chronic, often progressive disease in which a person craves alcohol and drinks despite repeated alcohol-related problems. Problems with alcohol can run the spectrum from mild drinking problem to life-threatening, and affect not only the alcoholic, but the alcoholic’s family as well as the general population in many negative ways.

Despite the focus on all of the illegal drugs of substance abuse (cocaine, crystal meth), alcohol is the number one substance abuse problem in the United States. 1 in 6, or almost 18 million adults are dependent upon alcohol, or have other alcohol-related problems. Teenagers most frequently abuse alcohol as well.

One in every three motor vehicle fatalities involves alcohol, 50% of drownings are due to alcohol, almost 20% of fire-related death, and almost 50% of murders are related to alcohol use. These shocking numbers are proof that we must work to help those who struggle with alcohol.

Alcoholism is often termed “a family disease” as alcohol negatively impacts the lives of family members and others close to the alcoholic in many ways. For the alcoholic to recover from alcoholism, family members must take part in recovery from alcohol abuse.

For people who are physically dependent upon alcohol, withdrawal from alcohol is far more dangerous than withdrawal from other substances of abuse.

What Is Alcohol Abuse Versus Alcohol Dependence?

Alcoholism can manifest itself in the forms of alcohol abuse or alcohol dependence:

Alcohol Abuse is defined as excessive, problematic use of alcohol in addition to one (or more) of the following:

  1. Failure to fulfill obligations at work, school or home.
  2. Legal problems or other problems with the law.
  3. Continued use of alcohol despite having problems caused by drinking.
  4. Recurrent alcohol use in dangerous situations.

Alcohol Dependence is a far more serious disorder, which involves extreme and maladaptive usage of alcohol, leading to three or more of the following:

  1. Increased tolerance for alcohol, requiring more and more to get the same effects.
  2. Inability to stop or cut back on drinking.
  3. Spending much of the time drinking or recovering from drinking.
  4. Drinking despite knowing the alcohol is causing problems.
  5. Drinking more alcohol (or drinking over a longer period of time than intended).
  6. Withdrawal symptoms if an attempt to stop drinking is made, or using alcohol as a means to keep withdrawal symptoms at bay.
  7. Giving up social or work activities to drink.
  8. Binge drinking, or drinking several drinks in a relatively short period of time.

What Causes Alcoholism?

There is no one single established cause for alcoholism. There is mounting evidence that there are both genetic and biologic predispositions for alcoholism, but it has not been proven.

Generally speaking, a number of factors lead to a person developing a problem with alcohol. Social factors, like peer pressure, familial influence, societal influences, as well as the availability may play a part in developing a problem with alcohol.

Psychological factors, like increased levels of stress, improper coping mechanisms, and reinforcement of drinking alcohol from other alcoholics can also play a factor in the development of alcoholism.

Twice as many men are dependent upon alcohol as women, and alcohol problems are highest within the 18-29 age bracket. People who begin to drink before age 21 are also at increased risk for the development of alcoholism.

Who Is At Risk for Alcoholism?

While alcoholism may not have a single cause, it is known that there are a number of risk factors that can lead to the development of problems with alcohol. These risk factors include:

Men who drink 15 or more alcoholic beverages a week (one drink equals one 12 oz beer, 5 oz of wine, or 1.5 oz of liquor).

Women who drink 12 or more alcoholic beverages a week.

Any person who has 5 or more drinks per occasion per week.

Individuals whose parents exhibit alcohol abuse or dependence.

Individuals who begin drinking at a young age.

Individuals who struggle with depression, anxiety, and other mental illnesses.

At great risk for the development of alcoholism are children of alcoholics. These children of alcohols are also at risk for a multitude of other problems, such as:

  • Substance abuse
  • Conduct disorders
  • Anxiety disorders
  • Mood disorders

What Are The Five Types of Alcoholics?

1) Young Adult Sub-types are the largest sub-type of alcoholics. Alcoholics by age twenty-four, they rarely seek treatment for alcoholism. They do drink less frequently than other types of alcoholics, but engage in binge-drinking when they do drink.

2)Young Antisocial Sub-type are twenty-six years old on average, often smoke cigarettes and pot but tend to become alcoholics by age eighteen. This sub-type doesn’t overlap with Young Adult alcoholics. Over half of them have antisocial personality disorder.

3) Functional Sub-type are generally middle-aged working adults who have stable relationships, higher education and higher income than other alcoholics. They drink every other day, five or more drinks on drinking days.

4) Immediate Familial Sub-type who typically began drinking at seventeen and became alcoholic by age thirty. Over half of these have an immediate family member who is an alcoholic.

5) Chronic Severe Sub-type is the rarest type. Mostly includes divorced men who frequently use illicit drugs.

What Are The Symptoms of Alcohol Abuse?

Alcoholism is a disease that is most often diagnosed through behaviors and problematic effects upon functioning, rather than a set of specific medical symptoms. In fact, only two of the diagnostic criteria are physiological (tolerance and withdrawal).

Abuse of alcohol and alcoholism are associated with a wide variety of social, legal, medical, psychiatric, occupational, economic, and family problems.

Most people who have problems with alcohol remain unrecognized by health care professionals, as an alcohol will often conceal the amount and type of drinking, deny that drinking is leading to problems, the onset of alcoholism is slow, the effects of alcoholism develop subtly, and the human body can adapt to the increasing amounts of alcohol in the system.

Family and loved ones of an alcoholic often deny or minimize the problems of the alcoholic, unintentionally contributing to the alcoholism, such as protecting the alcoholic from the problems associated with drinking, taking over the responsibilities of the family.

When confronted, alcoholics will usually deny that they drink too much or have a drinking problem. Because alcoholism, like other types of addiction, is influenced by the personality of the alcoholic, the symptoms and signs of alcoholism vary widely.

Some of the symptoms that a person has a problem with alcohol can include:

  • Anxiety
  • Frequent falling
  • Irritability
  • Many different bruises
  • Insomnia
  • Blacking out
  • Depression
  • Missing school or work
  • Losing a job
  • Divorce
  • Marital separation
  • Multiple car crashes
  • Weight loss
  • Appearing intoxicated often

Chronic alcohol abuse has medical conditions associated with the disease as well. Medical conditions associated with alcoholism can include the following:

  • Cirrhosis of the liver
  • Pancreatitis
  • Anemia
  • Alcoholic Neuropathy – malfunctioning of the nerves
  • Cerebellar atrophy
  • Alcoholic cardiomyopathy – heart disease
  • Wernike’s encephalopathy – abnormal functioning of the brain
  • Seizures
  • Korsakoff’s dementia
  • Confusion
  • Malnutrition
  • Hallucinations
  • Peptic ulcers
  • Bleeding in the GI tract.

Those who abuse alcohol are at great risk for mental illness and suicide as these individuals feel guilt, shame, and depression, especially when their disease causes significant losses in their lives (such as a divorce or losing a job).

How Is Alcoholism Diagnosed?

A diagnosis of alcoholism is usually made by observing a person’s behavior, unless the person is going through alcohol withdrawal or has other significant medical issues that warrant medical intervention.

Alcoholism is defined as the consumption of alcohol to the point that it interferes with a person’s personal, social, occupational or medical life. Because no two alcoholics are alike, it can be a challenge to make a diagnosis of alcoholism. However, there are several screening tests that health care providers may use to identify those at risk for alcoholism. These screening tests include:

Michigan Alcoholism Screening Test (MAST), which is a twenty-two question test often used by counselors.

CAGE Questionnaire: this screening tool asks only four questions. The more the “yes” answers, the greater the likelihood the person has a problem with alcohol:

  1. Have you ever felt you should Cut down on your drinking?
  2. Have people Annoyed you by criticizing your drinking?
  3. Have you ever felt Guilty about your drinking?
  4. Do you have a drink first thing in the morning (an Eye opener) to steady your nerves or get rid of a hangover?

TACE Questionnaire is similar to the CAGE Questionnaire. The more “yes” responses, the higher the likelihood the person has a problem with alcohol.

  1. How many drinks does it Take to get you drunk?
  2. Have people Annoyed you by criticizing your drinking?
  3. Have you ever felt you should Cut down on your drinking?
  4. Do you need an Eye-Opener drink each morning to steady your hands or get rid of your hangover?

Medical testing may be done to ascertain the extent of damage that alcohol has caused. These may include:

Laboratory blood draws may be performed to determine liver function, presence of anemia, electrolyte imbalances. Additional testing will be performed depending upon any medical complications.

What Is Alcoholic Ketoacidosis?

Alcoholic ketoacidosis (AKA) is a condition in which emergency medical treatment is necessary. Alcoholic ketoacidosis typically begins within four days after an alcoholic has stopped the consumption of alcohol, fluids, and food, generally from another medical problem, such as pancreatitis. AKA often occurs alongside alcohol withdrawal.

The signs of alcoholic ketoacidosis include, nausea, dehydration, and abdominal pain. These symptoms are caused by the burning of fat cells for energy, which releases ketone bodies. Ketone bodies are acids that accumulate in the blood, causing the person to feel increasingly sicker, perpetuating the viscous cycle.

How Is Alcoholism Treated?

It’s recommended that any alcoholic person seeking treatment for alcoholism utilize a team of medical professionals and therapy to ensure a safe, stable, and successful treatment. Treatment of alcoholism is divided into three stages:

1) Stabilization – the treating doctor must first make sure that person undergoing treatment for alcoholism is medically stable. This may include treatment of medical issues related or not related to the alcoholism. Alcohol withdrawal is treated with IV fluids and medications to reverse the symptoms of alcohol withdrawal.

2) Detoxification – during the detoxification stage (usually lasts a week) of alcoholism treatment, all consumption of alcohol will stop. As one can imagine, this stage is extremely difficult for an alcohol-dependent person and requires strict discipline and extensive support. Detox often occurs in an inpatient setting, where there is no alcohol available.

3) Rehabilitation – any treatment of alcoholism must include a long-term program to help treat those who are extremely dependent upon alcohol. Goals for rehabilitation include developing the skills not to drink, build a proper support system, and prevent relapses. Alcohol rehabilitation can occur in the following forms:

  • Short-Term Programs – these rehabilitation programs last less than four weeks and involve therapy, education, training of skills, and the development of a long-term plan to prevent relapsing.
  • Outpatient Counseling – this type of therapy is often the “step-down” after a stint in a rehabilitation center and can include individual, family, or group therapy. This type of therapy can help teach former alcoholics not to drink and spot early signs of a possible relapse.

4) Follow-Up – a person who suffers from alcoholism must make the decision on their own to stop abusing alcohol. Without such resolve, the goal of long-term sobriety may fall short. This can include:

  • The recovering alcoholic should find – and attend – a social support group or counseling.
  • The person should avoid any social situations that involve alcohol consumption.
  • Home should be kept alcohol-free to avoid an impulsive relapse.

What Are The Stages of Alcohol Withdrawal?

Withdrawal from alcohol requires medical treatment and care as alcohol withdrawal syndrome can be life-threatening. The 4 phases of alcohol withdrawal are as follows:

1) Tremulous Stage – tremor of hands and legs, especially evident if the person going through alcohol withdrawal attempts to hold out his or her hand. This stage of alcohol withdrawal is often accompanied by restlessness, anxiety, and agitation.

2) Seizures often follow the tremulous stage of alcohol withdrawal in 25% of people. These seizures are most often generalized seizures, during which the whole body shakes uncontrollably until the person loses consciousness.

3) Hallucinations affect 25% of people during the late stages of major alcohol withdrawal. Visual hallucinations, such as insects or worms crawling the walls or on their skin. Many times, these visual hallucinations are accompanied by tactile hallucinations; the alcoholic going through withdrawal may also feel the insects on their skin (where there are none), which is called formication. Less commonly, auditory hallucinations occur during alcohol withdrawal.

4) Delirium Tremens (DT’s), the most dangerous stage of alcohol withdrawal, affect 5% of people withdrawing from alcohol and begins 48-72 hours after alcohol use ceases. The hallmark of the DTs is pronounced delirium – the alcoholic is awake, but confused, agitated, sweating, hallucinating. The DTs also cause hypertension and tachycardia. The Delirium Tremens is a medical emergency. If untreated, death may occur in almost 35% people. Even with medical treatment, the DTs is associated with 5%-15% death rate.

Can Alcoholism Be Prevented?

Because there has been no research that has conclusively determined the root cause for alcoholism, the only way to prevent alcoholism is through abstaining from drinking. In order to become an alcoholic, one must first become dependent upon alcohol.

If there is a strong family history of alcoholism, there is an increased risk for the development of alcoholism. Knowing that there is, indeed, a risk for developing alcoholism can help modify the attitude toward alcohol.

Ensure that you have a strong social support system in place and if you should find yourself drinking too much or becoming dependent upon alcohol, seek immediate treatment for alcoholism.

What’s The Prognosis for Alcoholism?

Alcoholism is a chronic disease, much like heart disease or diabetes. A treatment success rate of 50% is very similar to those suffering other chronic conditions.

Being able to maintain sobriety is a challenge for anyone with an addiction, and with alcohol use being so prevalent in our society, it is understandable that many recovering alcoholics may relapse. For those who don’t seek follow-up treatment after alcohol detoxification, the relapse rate is as high as 60%.

The key factors that influence the relapse rate are:

  1. Higher levels of anger and frustration.
  2. Less education about addiction and ways to avoid urges to drink.
  3. Longer history of cravings and withdrawal symptoms.
  4. More frequent alcohol consumption prior to treatment.

If a person who struggles with alcoholism continues to drink after many ongoing treatments, the prognosis is very poor. Those who are persistent heavy drinkers often succumb to the effects of alcohol.

What Are Some Warning Signs Of Alcoholism?

If you or someone you love find yourself saying “yes” to a number of these questions, you may be abusing alcohol.

Do you or a loved one find yourself drinking alone?
Are you unable to decrease the amount you drink or stop drinking entirely?
Do you find yourself making excuses to drink?
Do you try to hide your drinking?
Do you become hostile when confronted by others about your drinking?
Do you miss work, school, or other social activities due to drinking?
Do you need alcohol to function during the day?
Are you irritable when sober?
Do you need alcohol to feel “normal?”
Do you find your hands shaking or trembling when you’re sober?
Are you taking care of yourself physically?

If you answered yes to a number of these questions, you may be abusing alcohol and should make an appointment to speak to your health care provider.

What Are The Signs of Alcohol Dependence?

Alcohol dependence is a very serious condition that comes with many medical, social, and lifestyle concerns. If you, or someone you love, can answer “yes” to a number of the following questions, you should immediately seek the care of your doctor.

Have you said yes to some of the above symptoms of alcohol abuse?

Do you experience black-outs (black-outs are memory lapses during periods of heavy drinking)?

Do you experience withdrawal symptoms during periods of sobriety?

Do you need greater amounts of alcohol to feel “drunk?”

Do you have an alcohol-related liver disease?

If you can answer yes to the above questions, seek immediate medical treatment. One should never attempt to stop drinking without a medical treatment plan.

If You or a Family Member Has a Drinking Problem:

Join a support group for people who are struggling with the same problems you are. Al-Anon, Alateen, and Adult Children of Alcoholics are all excellent support groups.

See a therapist, talk to a friend, or someone you can confide in. Isolation makes the situation much harder for you and your family.

Denying that there is a problem is damaging to you and to the rest of the family. As hard as it is to admit there is a problem, it can be liberating.

What Not To Do If Your Loved One Has A Drinking Problem:

Don’t cover up the problem or make excuses for the alcoholic.

Don’t take over responsibilities for the alcoholic as that will remove their dignity and sense of importance and enable their negative behavior.

Don’t be a martyr. Emotional appeals may further push the addict to abuse.

Don’t hide the bottles or shelter someone from situations where alcohol is present.

Don’t try to punish, threaten, preach or bribe the alcoholic.

Don’t ever, ever, EVER feel guilty or responsible for the behavior of the alcoholic. It’s not your fault. It cannot be your fault. You cannot make someone else do something they aren’t ready to do.

Additional Alcoholism Resources:

The 12-step programs, the Anonymous Programs, cover almost every addiction:

Alcoholics Anonymous The most widely used recovery and support group for alcoholics.

Al-Anon/Alateen 12-step recovery program for the families of alcoholics as alcoholism is a family disease.

Adult Children of Alcoholics– an anonymous 12-step program for adult children who grew up in an alcoholic home.

Additional Resources for Alcoholism:

National Institute on Alcohol Abuse– Research, publications, and resources about alcohol, alcoholism for families, health care providers and the general public.

Adult Children of Alcoholics, Janet G Woititz. This book provides wisdom and information for all adult children of dysfunctional families of alcoholics. It’s easily one of the best and most powerful books out there about growing up in an alcoholic home.

National Council on Alcoholism and Drug Dependence, Inc Information and resources on alcoholism and drug dependencies, as well as support for parents, young people, and recovering addicts. Online tests available to help you determine if you or your loved one should seek help.

Page last audited 7/2018