Alcohol Abuse

What Is Alcohol Abuse?

People have been brewing and fermenting alcoholic drinks since the dawn of civilization. Consumed in moderate amounts, alcoholic beverages are relaxing and in some cases may even have beneficial effects on health. Consumed in excess, alcohol is poisonous to human systems and is considered a drug. Nearly 100,000 Americans die each year as a result of alcohol abuse, and alcohol is a factor in more than half of the country's homicides, suicides, and traffic accidents. Alcohol abuse also plays a role in many social and domestic problems, from job absenteeism and crimes against property to spousal and child abuse.

The immediate physical effects of drinking alcohol range from mild mood changes to complete loss of coordination, vision, balance, and speech -- any of which can be signals of the temporary systemic poisoning known as acute alcohol intoxication, or drunkenness. These effects usually wear off in a matter of hours after a person stops drinking. Many law-enforcement agencies regard a .08 percentage of alcohol in the bloodstream as evidence of intoxication. Larger amounts of blood alcohol can impair brain function and eventually cause unconsciousness; an extreme overdose can be fatal.

Chronic alcoholism is a progressive, potentially fatal disease, characterized by an incessant craving for, increased tolerance of, physical dependence upon, and loss of control over drinking alcohol. The physical dependence on alcohol may or may not be obvious to other people. While some chronic alcoholics get very drunk, others exercise enough control to give the appearance of coping with everyday affairs in a near-normal way. However, alcoholism can lead to a number of physical ailments, including hypoglycemia, brain and heart damage, enlarged blood vessels in the skin, chronic gastritis, and pancreatitis.

Alcoholism can also lead to impotence in men, damage to the fetus in pregnant women, and an elevated risk of cancer of the larynx, esophagus, stomach, pancreas, and upper gastrointestinal tract. Because alcoholics seldom have adequate diets, they are likely to have nutritional deficiencies. Heavy drinkers typically have impaired liver function, and at least one in five develops cirrhosis.

The alcoholic's continual craving for alcohol makes abstinence -- an important goal of treatment -- extremely difficult. The condition is also complicated by denial: Alcoholics employ a range of psychological maneuvers to blame their problems on something other than drink, creating significant barriers to recovery. Historically, alcoholic behavior was blamed on a character flaw or weakness of will; many authorities now consider chronic alcoholism a disease that can afflict anyone.

Virtually every culture has warned against overuse of alcohol, and some have prohibited it outright, rarely with lasting success. While laws and educational programs in the United States are designed to prevent alcohol abuse, commercial and social pressure continues to put people at risk. Alcoholism is particularly insidious among young people and the elderly, in part because the symptoms are not easily recognized until the affected person becomes truly alcohol dependent.

What Causes It?

The cause of alcoholism seems to be a blend of genetic, physical, psychological, environmental, and social factors that vary among individuals. Genetic factors are considered crucial: A given person's risk of becoming an alcoholic is four to five times greater if a parent is alcoholic. Some children of alcohol abusers, however, overcome the hereditary pattern by becoming teetotalers.

What Are the Symptoms?

The following symptoms are associated with abuse of alcohol:

Temporary blackouts or memory loss. Recurrent arguments or fights with family members or friends. Continuing use of alcohol to relax, to cheer up, to sleep, to deal with problems, or to feel "normal." Headache, anxiety, insomnia, nausea, or other unpleasant symptoms when you stop drinking. Flushed skin and broken capillaries on the face; a husky voice; trembling hands; chronic diarrhea; and drinking alone, in the mornings, or in secret. These symptoms are specifically associated with chronic alcoholism.

Call Your Doctor If:

You have any of the symptoms listed in the description section and are unable to stop drinking on your own. You need medical intervention to treat alcoholism. You may also be susceptible to ailments such as cirrhosis, alcoholic hepatitis, and heart disease. You drink regularly and experience chronic or periodic depression. You may be at risk of suicide. You have tried to stop drinking and experienced withdrawal symptoms such as headache, anxiety, insomnia, nausea, or delirium tremens. You need medical attention by a doctor or a treatment center.

What Are the Treatments?

The goal of treatment is abstinence. Among alcoholics with otherwise good health, social support, and motivation, the likelihood of recovery is good: 50% to 60% remain abstinent at the end of a year's treatment, and a majority of those stay dry permanently. Those with poor social support, poor motivation, or psychiatric disorders tend to relapse within a few years of treatment. For these people, success is measured by longer periods of abstinence, reduced use of alcohol, better health, and improved social functioning.

Conventional Medicine

Treatment can begin only when the alcoholic accepts that the problem exists and agrees to stop drinking. He or she must understand that alcoholism is curable and must be motivated to change. Treatment has two stages: discontinuing alcohol use -- sometimes called detoxification -- and recovery. Because detoxification does not stop the craving for alcohol, recovery is often difficult to maintain. For a person in an early stage of alcoholism, discontinuing alcohol use may result in some withdrawal symptoms, including anxiety and poor sleep. Withdrawal from long-term dependence may bring the uncontrollable shaking, spasms, panic and hallucinations of delirium tremens (DT). If not treated professionally, people with DT have a mortality rate of more than 10%, so detoxification from late-stage alcoholism should be attempted under the care of an experienced provider and may require a brief inpatient stay at a hospital or treatment center.

Treatment may involve one or more medications. Benzodiazepines are antianxiety drugs used to treat withdrawal symptoms such as anxiety and poor sleep and to prevent seizures and delirium. These are the most frequently used medications during the detoxification phase, at which time they are usually tapered and then discontinued. They must be used with care, since they may be addictive. Disulfiram may be used once the detoxification phase is complete and the person is abstinent. It interferes with alcohol metabolism so that drinking a small amount will cause nausea, vomiting, confusion, and breathing difficulty. Naltrexone reduces the craving for alcohol but is recommended only in comprehensive programs that teach patients new coping skills. Tricyclic antidepressants may be used to control any resulting anxiety or depression, but because those symptoms may disappear with abstinence, the medications are usually not started until after detoxification is complete and there has been some period of abstinence.

Because an alcoholic remains susceptible to becoming dependent again, the key to recovery is total abstinence. Recovery typically takes a broad-based approach, which may include education programs, group therapy, family involvement, and participation in self-help groups. Alcoholics Anonymous (AA) is the most well known of the self-help groups, but other approaches have also proved successful.

Nutrition and Diet

Poor nutrition goes with heavy drinking: Because an ounce of alcohol has more than 200 calories but no nutritional value, ingesting large amounts of alcohol tells the body that it doesn't need more food. Alcoholics are often deficient in vitamins A, B complex, and C; folic acid; carnitine; magnesium, selenium, and zinc; as well as essential fatty acids and antioxidants. Restoring such nutrients -- by providing thiamine (vitamin B-1) and a multivitamin -- can aid recovery and are an important part of all detoxification programs.

At-Home Remedies

Abstinence is the most crucial -- and probably the most difficult -- step to recovery. To learn to live without alcohol, you must:

Avoid people and places that make drinking the norm, and find new, non-drinking friends. Join a self-help group. Enlist the help of family and friends. Replace your negative dependence on alcohol with positive dependencies such as a new hobby or volunteer work with church or civic groups. Start exercising. Exercise releases chemicals in the brain that provide a "natural high." Even a walk after dinner can be tranquilizing.

How Can I Prevent Alcohol Abuse?

Returning to drink is a major problem for recovering alcoholics; preventing this may be difficult, but it can be supported by continued therapy, positive motivation, and strong social support. Other ways to prevent relapse include changing routines, accepting a new sense of values, and avoiding activities or people associated with the drinking habit. For example, 90% of alcoholics smoke; alcoholics who stop smoking as well as drinking are more likely to achieve long-term abstinence -- to say nothing of the other health benefits.

A Self-Screening Test

No single symptom defines alcoholism, but honest answers to the following questions will help you decide if you are at risk.

Has a friend or relative ever suggested that you drink too much? Is it hard to stop drinking after you have had one or two drinks? Have you ever been unable to remember what you did during a drinking episode? Do you ever feel bad about how much you drink? Do you get into arguments or physical fights when you've been drinking? Have you ever been arrested or hospitalized because of drinking? Have you ever thought about getting help to control or stop your drinking?

If you answered yes to one or more questions, you may have a serious alcohol problem. For your own good, it's time to discuss the situation openly with a physician or mental health professional.