Alcohol Dependence

What Is It?

Alcoholism (alcohol dependence) is the most severe type of drinking problem. There is no absolute number of drinks per day or quantity of alcohol that defines alcoholism. Rather, it is defined by how a person's body reacts to alcohol and how the person behaves and thinks when he or she drinks.

People with alcohol dependence:

• Develop tolerance — They need to drink more and more alcohol to feel the same effects. They can also drink more than other people without getting drunk.

• Develop withdrawal symptoms — If they stop or cut back on drinking, they can experience anxiety, sweating, trembling, trouble sleeping, nausea or vomiting, and, in severe cases, physical seizures and hallucinations.

• Want to stop drinking, but they can't.

• Lose control over the amount of alcohol they drink.

• Become preoccupied with drinking.

• Payless attention to other life activities.

• Ignore problems.

A person with alcohol dependence has come to rely on alcohol physically, psychologically and emotionally. The brain adapts to the presence of alcohol and undergoes persistent changes. When alcohol use suddenly stops, the body's accustomed internal environment changes drastically, causing symptoms of withdrawal.

Alcoholism can be linked to a long list of psychological, interpersonal, social, economic and medical problems. Alcoholism can increase the risk of depression and suicide and play a role in violent crimes, including homicide and domestic violence (abuse of a spouse or child). It can lead to traffic accidents and even accidents involving intoxicated pedestrians who decide to walk home after drinking. Alcoholism also can lead to unsafe sexual behavior, resulting in accidental pregnancy or sexually transmitted diseases.

Alcohol dependence increases the risk of liver disease (hepatitis and cirrhosis), heart disease, stomach ulcers, brain damage, stroke and other health problems. In pregnant women who drink alcohol, there is also the danger that the child will develop fetal alcohol syndrome, a cluster of health problems including unusually low birth weight, facial abnormalities, heart defects and learning difficulties.

The lifetime chance of developing alcoholism is very difficult to determine, but it is very common. In the United States, about 1 in 16 adults have severe problems with drinking and millions more are engaged in what experts consider risky drinking.

lcohol problems are both biologically and environmentally based. People with a family history of alcohol dependence are at greater risk for developing the illness themselves. For example, if a parent has alcohol dependence, a child has a four-times greater risk of becoming alcohol-dependent. This is partly due to inheriting genes that increase vulnerability, perhaps by changing a person's physical responses to alcohol.

Environmental influences are important, too. Alcohol may be a big part of a person's social group. A person may turn to alcohol to get relief from stress (which frequently backfires, because the drinking causes problems of its own). Sometimes alcohol is used to blot out feelings of depression or anxiety. Family support and healthy friendships can reduce the risk.

Symptoms

Alcohol dependence can involve any of the following symptoms or behaviors:

• Having long episodes of intoxication

• Drinking alone

• Having work problems or financial problems caused by drinking

• Losing interest in food

• Being careless about personal appearance

• Having blackouts

• Driving drunk

• Hurting oneself or someone else while intoxicated

• Hiding liquor bottles and glasses to hide the evidence of drinking

• Experiencing mood or personality changes

Because large amounts of alcohol can be toxic to the body (for example, the cardiovascular, gastrointestinal or nervous systems), alcoholism also may cause physical symptoms:Á.çÞ

• Morning nausea or shaking

• Signs of malnutrition due to a poor diet

• Abdominal pain or diarrhea

• A flushed red color to the face and palms

• Numbness, weakness or tingling in the arms or legs

• Unusually frequent accidental injuries, especially falls

To help determine whether someone has an alcohol problem, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends taking the CAGE test. It is brief and simple and provides important information:

• Do you worry that you might need to CUT down on drinking?

• Do you feel ANNOYED because other people have criticized your drinking?

• Do you feel GUILTY about drinking?

• Do you need a morning EYE OPENER drink to steady your nerves or to fight a hangover?

Responding yes to one of these questions means you may have a drinking problem. Answering yes to more than one means a drinking problem is highly likely.

Diagnosis

Your doctor may use the CAGE questions or some other screening questionnaire that is used to assess drinking problems. One alternative to CAGE is the 10-question AUDIT (Alcohol Use Disorders Identification Test) developed by the World Health Organization. The doctor should also ask you about your history of using alcohol and other drugs.

He or she also will ask about any alcohol-related problems that you might have had at work, at home or with the law, such as getting into fights or driving while intoxicated. Your doctor also may ask about any physical symptoms of alcoholism. These questions are often embarrassing to answer truthfully. Your doctor should view alcoholism as an illness that can be treated, and should not respond to you as if you had a reason to be ashamed. Your doctor is in a better position to help you if you can be honest.

Your doctor will examine you, carefully checking for signs of poor nutrition and alcohol-related liver or nerve damage. He or she also will order blood tests to check for anemia, vitamin deficiencies and abnormal levels of liver chemicals.

Expected Duration

For most people who have alcohol dependence, the first alcohol-related life problem usually appears in the mid-20s to early 40s. Left untreated, alcoholism often persists and gets worse over time. Up to 30% of people with alcohol dependence do manage to abstain from alcohol or control their drinking without formal treatment. On the other hand, the illness can be fatal — there are approximately 100,000 alcohol-related deaths per year in the United States.

Prevention

There is no absolute way to prevent alcoholism. However, strong family support and solid relationships with non-drinking friends can help. Children of alcoholics can contact Alateen by calling 1-888-425-2666.

Treatment

Only a minority of people can regain control of their drinking. More often, once a person has lost control of his or her drinking, it is difficult to go back to drinking moderate amounts. Therefore, the goal of treatment of alcohol dependence is usually to stop drinking alcohol completely.

The first step in this process is recognizing the problem. The well-known phenomenon of denial, which is a common part of the illness, often turns the illness into a chronic one. Unfortunately, the longer the illness persists, the harder it is to treat.

A doctor or substance abuse expert may be able to help the person look at the consequences of drinking. If an individual is beginning to think about alcohol as a problem, educational groups may provide support for weighing the pros and cons of drinking.

It is never easy for family members and friends to confront the problem. A professional may have to help loved ones — kindly, but firmly — talk to the drinker about the painful impact drinking has on them.

The next step is to stop drinking and get treatment to prevent dangerous withdrawal symptoms, a process called detoxification (or simply "detox"). Depending on your symptoms, this can be done as an outpatient, or as an inpatient in a hospital or drug treatment facility. During the withdrawal process, your doctor probably will prescribe a class of antianxiety drugs called benzodiazepines for a few days to lessen withdrawal symptoms.

After weaning from alcohol, you may be offered a medication to help reduce cravings. Two medications that fit in this category are naltrexone (ReVia) and acamprosate (Campral). As an alternative, sometimes the drug disulfiram (Antabuse) may be prescribed. This drug does not reduce craving, but it creates an incentive not to drink, because drinking alcohol while taking disulfiram causes nausea and vomiting.

After detoxification, most alcoholics need some form of long-term support or counseling to remain sober. Recovery programs focus on teaching a person with alcoholism about the disease, and helping him or her to learn new coping strategies to deal with the stresses of everyday life without turning to alcohol. Psychotherapy may help a person deal with the underlying stresses and influences that trigger drinking. Many patients benefit from self-help groups such as Alcoholics Anonymous (AA), Rational Recovery or SMART (Self Management and Recovery Training).

It is very important to treat any other problems, such as depression or anxiety, that may contribute to the risk of drinking.

If your doctor suspects that you have any alcohol-related damage to your liver, stomach or other organs, you may need additional tests and treatments for these problems. Your doctor also will suggest a healthy diet with vitamin supplements, especially B vitamins.

When To Call a Professional

Call your doctor whenever you or someone you love has an alcohol-related problem. Remember, alcoholism is an illness that can be treated, not a sign of weakness or poor character. The sooner treatment begins, the easier alcoholism is to treat.

Prognosis

About 30% of alcoholics are able to abstain from alcohol permanently without the help of formal treatment or a self-help program. For the rest, the course of the illness is very varied. Some people will go through periods where they remain sober, but then relapse. Others have a hard time sustaining any period of sobriety.

It is clear, however, that the more sober days you have, the greater the chance that you will remain sober. Another motivating fact: remaining sober can increase life expectancy by 15 or more years.