Alcoholism or
Alcohol Dependence, chronic disease marked by a craving for
alcohol. People who suffer from this illness are known as alcoholics. They
cannot control their drinking even when it becomes the underlying cause of
serious harm, including medical disorders, marital difficulties, job loss, or
automobile crashes. Medical science has yet to identify the exact cause of
alcoholism, but research suggests that genetic, psychological, and social
factors influence its development. Alcoholism cannot be cured yet, but various
treatment options can help an alcoholic avoid drinking and regain a healthy
life.
People tend to equate
any kind of excessive drinking with alcoholism. But doctors and scientists
recognize that disorders related to alcohol use lie along a continuum of
severity. They prefer to use the term alcohol
dependence instead of alcoholism
to designate the most severe of the alcohol-use disorders. The terms alcohol abuse and problem drinking designate less severe disorders resulting from
immoderate drinking.
Alcohol dependence develops
differently in each individual. But certain symptoms characterize the illness,
according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), a
United States government agency that is part of the National Institutes of
Health. Alcoholics develop a craving, or a strong urge, to drink despite
awareness that drinking is creating problems in their lives. They suffer from
impaired control, an inability to stop drinking once they have begun.
Alcoholics also become physically dependent on alcohol. When they stop
drinking after a period of heavy alcohol use, they suffer unpleasant physical
ailments, known as withdrawal symptoms, that include nausea, sweating,
shakiness, and anxiety (see Drug
Dependence). Alcoholics develop a greater tolerance for alcohol—that is, they
need to drink increasing amounts of alcohol to reach intoxication. The World
Health Organization (WHO) notes that other behaviors common in people who are
alcohol dependent include seeking out opportunities to drink alcoholic
beverages—often to the exclusion of other activities—and rapidly returning to
established drinking patterns following periods of abstinence.
II.
|
PREVALENCE
|
Alcohol dependence affects
a broad cross section of society around the world. Statistics show that
alcohol dependence touches successful business executives, skilled mechanics,
laborers, homemakers, and church members of all denominations. Scientists have
not identified a typical alcoholic personality, and they cannot predict with
absolute certainty which drinkers will progress to alcohol dependence.
Alcohol use varies depending
on an individual’s social, cultural, or religious background. Some individuals
do not drink at all—about one-third of adults in the United States who are 18
and older, for example, abstain from alcohol. Others drink as part of social
custom. Still others drink frequently and in substantial amounts. Those
suffering from alcohol dependence drink to appease an uncontrolled craving for
alcohol or to avoid experiencing the unpleasant symptoms of withdrawal.
WHO estimates that about
76 million people worldwide suffer from alcohol-related disorders. The
prevalence of the illness varies in different countries. In the United States
about 15 percent of the population experiences problems related to their use
of alcohol. Of these, alcohol dependence affects about 12.5 million men and
women, or almost 4 percent of the population. Men are three times more likely
than women to become alcoholics, while people aged 65 and older have the
lowest rates of alcohol dependence.
In the United States,
people who start to drink at an early age are at particular risk for
developing alcohol dependence. Estimates indicate that 40 percent of people
who begin to drink before age 15 will become alcohol dependent at some point
in their lives. These individuals are four times more likely to become alcohol
dependent than those who delay drinking until age 21.
In Canada, an estimated
4 percent of the people aged 15 and older are alcohol dependent, and the
number of male alcoholics is double that of females. The highest rate of this
illness occurs in Canadians between the ages of 20 and 24. In Canadian surveys
about one in five current and former drinkers admit that their drinking harmed
them at some point in their lives, affecting their jobs or financial position.
Alcohol dependence has
reached critical proportions in Russia, where it is estimated that almost a
third of all deaths are related, directly or indirectly, to alcohol abuse.
Periodic efforts by the government to control drinking by closing distilleries,
breweries, and bars have backfired. Instead of solving the problem, such
tactics only created a widespread black market for liquor—as well as a country
of people who hide their drinking problems.
In Asian nations such
as Japan, alcohol abuse has become a social concern. In these countries,
drinking almost is required when conducting business. Bars are an extension of
offices, places where key decisions are made. A person who declines an
invitation to a drink after work risks being passed over for promotion within
the company. Alcohol is readily available in Japan—vending machines along the
streets of Tokyo dispense cans of beer and sake.
PHYSICAL EFFECTS OF
ALCOHOL
IV.
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SOCIAL EFFECTS OF
ALCOHOLISM
|
Throughout most of history,
society has viewed people who drink to excess as irresponsible, immoral, and
of weak character. Punishment of drunkards was considered necessary to protect
the community. By the early 1900s, experts conceded that alcohol dependence
may result from tissue changes caused by the action of alcohol. These changes
produce a continued need to drink, such that the individual seeks larger
amounts of alcohol at more frequent intervals. However, society still regarded
taking or rejecting a drink as a matter of personal decision, thus all
excessive drinking was considered a voluntary act. The individual, therefore,
was held responsible for his or her behavior.
Although a consensus is
growing among health professionals that alcohol dependence is a disease,
society’s attitudes toward individuals with drinking problems remain
ambivalent and confused. Until the mid-20th century, the typical picture of
the alcoholic was of someone without steady employment, unable to sustain
family relationships and most likely in desperate financial straits. But this
stereotype was largely dispelled when highly respected people publicly
admitted their alcohol dependence and shared their successful recovery
stories. Particularly critical in changing the way Americans view alcohol-use
disorders were New York broker William Griffith Wilson (more familiarly known
as Bill W.) and Ohio physician Robert Holbrook Smith (Dr. Bob). In 1935 these
two recovered alcoholics developed a program to promote their successful
philosophy for recovering from alcohol dependence. The program, which became
known as Alcoholics Anonymous, has spread around the world, helping millions
of members to avoid alcohol use and rebuild their lives. In the late 1970s
Betty Ford, the wife of former U.S. president Gerald Ford, disclosed her
struggle to recover from alcohol dependence. She helped raise the public’s
understanding about alcohol dependence through her open, honest revelations
and her creation of a groundbreaking treatment center for substance abusers in
Rancho Mirage, California, now known as the Betty Ford Center.
Intoxication threatens
not only the individual who drinks but also the surrounding community.
Therefore, societies around the world have attempted to control excessive use
of alcohol. Temperance societies in the 19th and 20th centuries pushed for laws
ranging from arrest and jail sentences for public drunkenness to prohibition
of the manufacture, distribution, and consumption of alcoholic beverages.
Today experts characterize
alcohol-use disorders as a form of illness, and one so widespread that it
constitutes a major public health problem. According to WHO, alcohol
dependence and other alcohol-use disorders undermine global health, accounting
for 3.5 percent of the total cases of disease worldwide. This figure equals
the hazards posed by unsafe sex and surpasses two other formidable health
foes, tobacco and illicit drugs. In the United States alone, the NIAAA
estimates that alcoholism causes losses of more than $185 billion a year in
lost productivity, illness, and premature death.
V.
|
DEVELOPMENT OF
ALCOHOL DEPENDENCE
|
Alcohol-use disorders
develop in a predictable pattern. Health professionals use three stages to
describe this progression. Each stage is defined by a set of symptoms that are
used in early diagnosis and treatment. Most individuals who drink alcohol
never progress beyond stage one and are commonly known as social drinkers. In
this stage, individuals drink alcohol primarily as an accompaniment to social
situations. Drinking at this stage is not the central focus of a person’s
activities.
A small percentage of
social drinkers progress to stage two. In this early stage of a drinking
problem, many people do not show any signs of illness. But often, more severe
problems develop with time and continued heavy drinking. Activities that focus
on drinking may take up increasingly larger amounts of time in the person’s
life, and as problem drinking progresses the alcoholic’s intoxicated behavior
may become disagreeable and antisocial. A person may resort to drinking to
relieve the physical discomfort of withdrawal symptoms. Most often, attempts
to avoid the discomfort result in morning drinking to offset symptoms that
develop after a bout of drinking the night before.
As drinking continues,
drinkers cannot acknowledge that drinking and intoxication have become goals
in themselves. Drinking may become a technique for coping with problems, many
of which have been brought about by alcohol use. Drinkers may neglect
responsibilities to their family, seriously damaging relationships with their
partners and children. Their productivity at work declines, often resulting in
job loss. Despite numerous negative consequences experienced as a result of
their drinking, they remain in denial about their problem. They continue to
claim to friends or family that they can stop drinking any time they want to.
But in actuality they find it increasingly difficult to control their alcohol
use.
Stage three is the final
stage of alcohol dependence. In addition to suffering from many of the
problems experienced by individuals in stage two, an individual in stage three
can no longer control his or her drinking. This impaired control, in which the
compulsion to drink is overwhelming, is the key identifier that health
professionals use to diagnose people who have progressed to alcohol
dependence.
VI.
|
CAUSES
|
Scientists do not know
precisely what causes alcoholism, but most experts suspect that a combination
of factors are involved, which may explain why some people who drink become
alcohol dependent while most do not.
A.
|
Physiological
Causes
|
Scientists have explored
the chemical action of alcohol among both normal individuals and individuals
who suffer from alcohol-use disorders, particularly alcohol dependence. Some
studies suggest that some people may have a physical trait that enables them
to drink large quantities of alcohol before feeling its intoxicating effects.
These people have an enhanced tolerance for alcohol. Scientists are unsure if
this trait causes excessive drinking or develops as the result of such
drinking.
Studies show that alcoholism
runs in families—alcoholics are six times more likely than nonalcoholics to
have blood relatives who are alcohol dependent. Researchers have long pondered
whether these familial patterns result from genetics or from a common home
environment, which often includes alcoholic parents. Studies of twins attempt
to identify if alcohol dependence develops as the result of genetic factors,
shared environmental influences, or a combination of both. Laboratory studies
compare the genetic structure in people who are alcohol dependent with those
who have no personal or family history of the disease.
Studies of twins in the
1980s showed that patterns of alcohol dependence differed among identical
twins, who share identical genes, and fraternal twins, who are genetically
different. If one twin becomes alcohol dependent, an identical twin is more
likely to develop alcohol dependence than a fraternal twin. While these
studies suggest that a genetic factor plays a role in alcohol dependence, the
results are difficult to interpret. Many of these studies assumed that all
twins share a similar home environment. But more recent studies revealed that
the home environments of identical twins are more alike than the environments
of fraternal twins. That is, as children, identical twins are more likely than
fraternal twins to play and study together and to share friends. And as
adults, identical twins are more likely than fraternal twins to stay in close
contact with each other, possibly resulting in the development of similar
behaviors. Scientists are conducting further twin studies that take into
account differences in home environments.
Scientists now recognize
that alcoholism is a polygenic disease—that is, many genes are involved in
increasing an individual’s risk for developing alcohol dependence. In addition
to family studies that establish a broad genetic influence on alcoholism,
scientists perform laboratory studies to try to identify the specific genes
involved in the development of alcohol dependence. One method scientists use
is to look for genetic markers related to alcoholism. A genetic marker is a
gene that produces an observable trait and has a known location on a
chromosome, the rod-shaped structures that carry genes. Once scientists have
identified genetic markers, they attempt to determine if the markers are
inherited in people with alcoholism. If the marker is inherited along with
alcoholism, scientists know that the genes that cause alcoholism are likely
located close to the genetic marker on the chromosome.
In 1998 researchers moved
closer to the goal of finding the genes for alcoholism when they identified
locations on four chromosomes where these genes are likely to be. Some experts
speculate that these genes may not be specific for alcohol dependence, but
rather may determine temperament or personality traits that increase a
person’s vulnerability to alcohol-use disorders.
B.
|
Environmental
Causes
|
Scientists recognize that
alcohol-use disorders likely results from a complex interaction of biological
influences and environmental factors. Environmental factors that may affect
the development of the disease include personal behavioral skills, peer
influences early in life, parental behavior, societal and cultural attitudes
toward alcohol use, life stress, and availability of alcoholic beverages. Once
a person has established a drinking pattern, environmental factors combined
with physical changes induced by heavy drinking may reinforce the continued
use of alcohol.
C.
|
Psychological
Influences
|
Many experts believe that
a loss of control over drinking is as much psychological as it is
physiological. Studies show that alcohol-dependent individuals will drink
excessive amounts of a nonalcoholic beverage if they believe it contains alcohol.
Moreover, when they are given an alcoholic beverage that they believe is
alcohol-free, their drinking behavior is similar to that of persons not
dependent on alcohol.
Many drinkers develop
a psychological condition known as denial, in which they are unable to
acknowledge that alcohol use lies at the root of many of their problems.
Denial was long thought to be a personality trait shared by all persons who suffer
from alcohol-use disorders. Recent research suggests that denial may be a
psychological response to negative feedback people receive about their
drinking. Some studies indicate that when approached with objective
information about their drinking and its consequences in an empathetic and
nonconfrontational manner, many persons with significant drinking problems do
not demonstrate denial.
VII.
|
HEALTH
CONSEQUENCES
|
|
||
While some studies have
found that moderate use of alcohol has beneficial health effects, including
protection from coronary heart disease, heavy and prolonged intake of alcohol
can seriously disturb body chemistry. Heavy drinkers lose their appetite and
tend to obtain calories from alcohol rather than from ordinary foods. Alcohol
is rich in calories and can provide substantial amounts of energy. However, if
it constitutes the primary source of calories in place of food, the body will
lack vitamins, minerals, and other essential nutrients.
Prolonged use of large
amounts of alcohol may cause serious liver damage. In the first stage of liver
disease caused by alcohol, fat accumulates in the liver. This stage of the
disease is known as fatty liver. Most people do not notice symptoms of fatty
liver, although in some people the liver becomes enlarged and tender. Some
people with fatty liver develop hepatitis, which inflames and kills liver
cells. Hepatitis is marked by jaundice, which gives a yellowish tint to the
eyes and skin. Others may develop cirrhosis, an irreversible condition in
which normal liver tissue is replaced by scar tissue. The scarring prevents
blood from traveling freely through the liver, building blood pressure in the
veins that run from the intestine to the liver. Consequently, the liver can no
longer process toxins efficiently, causing poisons to build up in the blood.
This buildup can be fatal.
Heavy drinking also damages
heart muscle. Nearly half of all cases of cardiomyopathy are caused by alcohol
abuse. In this heart disease, the heart muscles, particularly the right and
left ventricles, enlarge and become flabby, reducing the heart’s blood-pumping
efficiency. This inefficiency reduces the flow of blood through the kidneys,
which normally filter excess salts and water out of the blood. Eventually the
blood volume rises, causing a potentially fatal backup of fluid in the lungs.
The best methods to treat
alcohol dependency vary, depending upon an individual’s medical and personal
needs. Some heavy drinkers who recognize their problem appear to recover on
their own. Others recover through participation in the programs of Alcoholics
Anonymous or other self-help groups. Some alcoholics require long-term
individual or group therapy, which may include hospitalization. And still
others do not seek treatment at all. These people do not seek treatment as the
result of a combination of factors, including ignorance of the symptoms of
alcohol-use disorders, the social stigma that still surrounds these
disorders—that is, the fear of being labeled an alcoholic—and an unwillingness
to accept lifetime abstinence from alcohol as a treatment goal.
Numerous studies indicate
that simple, brief interventions can be effective in changing drinking
behavior in those who are not severely alcohol dependent. In brief
interventions, a problem drinker meets with a health professional for one to
four sessions, with each session lasting from a few minutes to an hour. During
these meetings, the health professional makes the person aware that his or her
current drinking patterns or medical problems are related to alcohol abuse and
could progress to alcohol dependence. Using a warm, reflective, and
understanding style of delivery, the health professional employs a variety of
strategies to encourage the individual to change his or her drinking behavior.
The goal of brief interventions typically is to help people moderate their
drinking rather than resort to complete abstinence. Brief interventions also
have been used to motivate alcoholics to enter specialized treatment programs
and work toward complete abstinence from alcohol.
For some alcoholics, treatment
begins with detoxification, which safely rids the patient’s body of alcohol
while treating any physical complications that develop from severe withdrawal
symptoms, such as delirium tremens. Detoxification normally requires less than
a week, during which time patients usually stay in a specialized residential
treatment facility or a separate unit within a general or psychiatric
hospital. These facilities also offer extended treatment programs to help
alcoholics in their recovery effort.
Recovery also may involve
individual counseling and group therapy to help a person who is alcohol
dependent adapt to a new way of life, one that is not driven by alcohol.
Throughout the United States and Canada, public outpatient and inpatient
clinics offer a variety of treatments for alcoholics. The National Council on
Alcoholism and Drug Dependence (NCADD) has affiliates in many cities that help
people who are alcohol dependent find appropriate treatment programs. Many
public mental hospitals and Veterans Administration hospitals, as well as
private clinics and hospitals, treat alcohol dependence.
Physicians may prescribe
medications to help prevent alcoholics from returning to drinking once they
have stopped. The drug disulfiram (sold under the trade name Antabuse), interferes with the way the body
processes alcohol. Taken in pill form daily, this medication generally has no
noticeable effects until a person drinks alcohol. The alcohol and drug
interact to produce an extremely unpleasant reaction, including nausea,
dizziness, headache, heart palpitations, and other problems. Alcoholics then
associate illness with drinking and, in many cases, avoid alcohol use.
Naltrexone (ReViva) is a narcotic
approved for use in alcohol treatment in 1995. Although scientists are not
certain how this medication works in the brain, it reduces an alcoholic’s
craving for alcohol, most likely by blocking the positive effects the
individual gets from drinking alcohol. Naltrexone is most effective when it is
used in combination with counseling programs. Acamprosate (trade name, Campral) is used to help alcoholics maintain
abstinence once they have ceased drinking. Scientists believe it works by
restoring balance among the chemicals that enable brain cells to communicate
with one another. Alcohol dependence disrupts this balance.
Most treatment programs
effectively help alcohol-dependent persons stop drinking for a period, but
they are less successful in preventing a subsequent return to drinking.
Treatment programs typically contain a component that focuses on helping alcoholics
understand the situations, feelings, and interpersonal interactions that
trigger drinking. These programs teach people how to cope with these factors
without returning to drinking.
In addition to formal
treatment programs, other widely available community resources include
vocational rehabilitation, family guidance, and religious counseling. Many
countries, including Poland, Finland, and South Africa, and some U.S. states
have compulsory treatment programs for alcoholics who have committed crimes.
Mutual-help organizations, such as Alcoholics Anonymous and Rational Recovery,
provide a free and effective method to cope with recovery.
Source: Microsoft
® Encarta ® 2009. © 1993-2008
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