An illness marked by consumption of alcoholic beverages at a level that interferes with physical or mental health, and social, family, or occupational responsibilities. People with alcohol dependence, the most severe alcohol disorder, usually experience tolerance (a need for markedly increased amounts of alcohol to achieve intoxication or the desired effect), and withdrawal symptoms when alcohol is discontinued or intake is decreased. They also spend a great deal of time drinking alcohol, and obtaining it. Alcohol abusers are "problem drinkers", that is, they may have legal problems, such as drinking and driving, or binge drinking (drinking six or more drinks on one occasion). People who are dependent on or abuse alcohol return to its use despite evidence of physical or psychological problems, though those with dependence have more severe problems and a greater compulsion to drink.

Alternative Names

Alcohol dependence; Alcohol abuse

Causes, incidence, and risk factors

Alcoholism is a type of drug addiction. There is both physical and psychological dependence with this addiction. Physical dependence reveals itself by withdrawal symptoms when alcohol intake is interrupted, tolerance to the effects of alcohol, and evidence of alcohol-associated illnesses. Alcohol affects the central nervous system as a depressant, resulting in a decrease of activity, anxiety , tension , and inhibitions. Even a few drinks can result in behavioral changes, a slowing in motor performance, and a decrease in the ability to think clearly. Concentration and judgment become impaired. In excessive amounts, intoxication may result. Alcohol also affects other body systems. Irritation of the gastrointestinal tract can occur with erosion of the lining of the esophagus and stomach causing nausea and vomiting , and possibly even bleeding. Vitamins are not absorbed properly, which can lead to nutritional deficiencies with the long-term use of alcohol. Liver disease , called alcoholic hepatitis, may also develop and can progress to cirrhosis. The heart may be affected by cardiomyopathy . Sexual dysfunction can also occur, causing erectile dysfunction in men and cessation of menstruation in women. Alcohol affects the nervous system and can result in neuropathy and dementia. Chronic alcohol use also increases the risk of cancer of the larynx, esophagus, liver, and colon. Alcohol consumption during pregnancy can cause severe birth defects. The most serious is fetal alcohol syndrome, which may result in mental retardation and behavior problems; a milder form of the condition which can still cause lifelong impairment is called fetal alcohol affects. The social consequences of problem drinking and alcohol dependence can be as serious as the medical problems. People who abuse or are dependent on alcohol have a higher incidence of unemployment, domestic violence, and problems with the law. About half of all traffic fatalities are related to alcohol use. The development of dependence on alcohol may occur over a period of years, following a relatively consistent pattern of progression. At first, a tolerance of alcohol develops. This results in a person being able to consume a greater quantity of alcohol before its adverse effects are noticed. Memory lapses ("black outs")relating to drinking episodes may follow tolerance. Then, people may lose control over drinking and find it difficult or impossible to stop if they try. The most severe drinking behavior includes prolonged binges of drinking with associated mental or physical complications. Some people are able to gain control over their dependence in earlier phases before a total lack of control occurs-- the problem is, no one knows which heavy drinkers will be able to regain control and which will not. Withdrawal develops because the brain has physically adapted to the presence of alcohol and cannot function adequately in the absence of the drug. Symptoms of withdrawal may include elevated temperature, increased blood pressure, rapid heart rate, restlessness, anxiety, psychosis, seizures, and rarely even death. There is no known common cause of alcoholism; however, several factors may play a role in its development. A person who has an alcoholic parent is more likely to become an alcoholic than a person without alcoholism in the immediate family. Research suggests that certain genes may increase the risk of alcoholism but which genes or how they exert their influence is controversial. Psychological factors may include a need for relief of anxiety, ongoing depression, unresolved conflict within relationships, or low self-esteem. Social factors include availability of alcohol, social acceptance of the use of alcohol, peer pressure, and stressful lifestyles. The i ncidence of alcohol intake and related problems is increasing. Data from many sources indicate that about 15% of the population in the United States are "problem drinkers", and approximately 5% to 10% of male drinkers and 3% to 5% of female drinkers could be diagnosed as alcohol dependent (12.5million people).

Signs and tests

All physicians should ask their patients about their drinking. A history may be obtained from family if the affected person is unwilling or unable to answer questions. A physical examination is performed to identify physical problems related to alcohol use.

A

toxicology screen or blood alcohol level confirms recent alcohol ingestion (which does not necessarily confirm alcoholism).

Liver function tests

can be elevated. GGPT (glutaryl transaminase) is often elevated more than other liver function tests.

CBC (complete blood count) - MCV can be elevated (mean corpuscular volume or size of the red blood cells).

Sometimes serum magnesium, uric acid, total protein, and folate tests are abnormal.

Treatment

Many people with alcohol problems don't recognize when their drinking gets out of hand. In the past, treatment providers believed that alcoholics should be "confronted" about "denial" of their drinking problems, but now research has shown that compassionate and empathetic counseling is more effective. Three general steps are involved in treating the alcoholic once the disorder has been diagnosed: intervention, detoxification, and rehabilitation. Research finds that the traditional confrontational intervention where family members or the employer surprises the alcoholic and threaten consequences if treatment is not begun is *not* effective. Studies find that more people enter treatment if their family members or employers are honest with them about their concerns and gradually help them to see for themselves that drinking is a problem by showing how it is preventing them from reaching their own goals. Once the problem has been recognized, total abstinence from alcohol is required for those who are dependent; for those who are "problem drinkers," moderation may be successful. Since many alcoholics initially refuse to believe that their drinking is out of control, a trial of moderation can often be an effective way to deal with the problem-- if it succeeds, the problem is solved; if not, the person is usually ready to try abstinence. Because alcoholism affects the people closely related to the alcoholic person, treatment for family members through counseling is often necessary. Detoxification is the first phase of treatment. Alcohol is withdrawn under a controlled, supervised setting. Tranquilizers and sedatives are often prescribed to control alcohol withdrawal symptoms. Detoxification usually takes 4 to 7 days. Examination for other medical problems is necessary, for example, liver and blood clotting problems are common. A balanced diet with vitamin supplements is important. Complications associated with the acute withdrawal of alcohol may occur, such as delirium tremens ( DT's ),which could be fatal. Depression or other underlying mood disorders should be treated. Often, alcohol abuse develops from efforts to self-treat an illness. Alcohol recovery or rehabilitation programs support the affected person after detoxification to maintain abstinence from alcohol. Counseling, psychological support, nursing, and medical care are usually available within these programs. Education about the disease of alcoholism and its effects is part of the therapy. Many of the professional staff involved in rehabilitation centers are recovering alcoholics who serve as role models. Programs can be either inpatient, with the patient residing in the facility during the treatment, or outpatient, with the patient attending the program while they reside at home. Medications are sometimes prescribed to prevent relapses. Naltrexone (an opioid antagonist) decreases alcohol cravings. Disulfiram (Antabuse) works by producing very unpleasant side effects if even a small amount of alcohol is ingested within 2 weeks after taking the drug. These medications are not given during pregnancy or if the person has certain medical conditions. Long-term treatment with counseling or support groups is often necessary. The effectiveness of medication and counseling varies. Alcoholics Anonymous is a self-help group of recovering alcoholics that offers emotional support and an effective model of abstinence for people recovering from alcohol dependence. There are more than 1 million members worldwide, and local chapters are found throughout the United States. Al-Anon is a support group for spouses and others who are affected by someone else's alcoholism. Alateen provides support for teenage children of alcoholics. See alcoholism - support group . For those who don't like the twelve-step approach, there are several other support groups available. It is important that people dealing with alcohol problems know about these other groups because in the past, those who did not find AA helpful or were troubled by its requirement of submission to a "Higher Power" had no alternatives. SMART recovery uses research-based cognitive techniques to help alcoholics recover. LifeRing recovery and SOS are two other secular programs. Women For Sobriety is a self help group just for women-- many female alcoholics have different concerns than men. Moderation Management is a program for problem drinkers seeking to moderate their drinking-- it recommends abstinence for those who fail at such attempts.

Support groups

Members of AA have help available 24 hours a day, associate with a sober peer group, learn that it is possible to participate in social functions without drinking, and are given a model of recovery by observing the accomplishments of sober members of the group. Other support groups are smaller, but growing and all have an online presence which provides support even at home late at night.

Expectations (prognosis)

Alcoholism is a major social, economic, and public health problem. Alcohol is involved in more than half of all accidental deaths and almost half of all traffic fatalities. A high percentage of suicides involve the use of alcohol in combination with other substances. Additional deaths are related to the long-term medical complications associated with the disease. Only 15% of those with alcohol dependence seek treatment for this disease. Relapse after treatment is common so it is important to maintain support systems in order to cope with any slips and ensure that they don't turn into complete reversals. Treatment programs have varying success rates, but many people with alcohol dependency have a full recovery.

Complications

acute pancreatitis

and

chronic pancreatitis

alcoholic cardiomyopathy

alcoholic neuropathy

bleeding esophageal varices

cerebellar degeneration

cirrhosis of the liver

complicated alcohol abstinence

(delirium tremens)

depression

erectile dysfunction

fetal alcohol syndrome in the offspring of alcoholic women

high blood pressure

increased

incidence of cancer

insomnia

nutritional deficiencies

suicide

Wernicke-Korsakoff syndrome

Calling your health care provider

If severe

confusion , seizures , bleeding , or other health problems develop in a person known or who is suspected to have alcohol dependence take him/her to the emergency room or call the local emergency number (such as 911).

Prevention

Educational programs and medical advice about alcohol abuse have been successful in decreasing alcohol abuse and its associated problems. Alcohol dependency requires more intensive management. The National Institute on Alcohol Abuse and Alcoholism recommends that women have no more than one drink per day and men no more than two drinks per day. One drink is defined as a 12-ounce bottle of beer; a 5-ounce glass of wine; or a 1 1/2-ounce shot of liquor.