Alcoholism

Alcoholism is also known as alcohol dependence. It occurs when you drink so much over time that your body becomes dependent on or addicted to alcohol. When this happens, alcohol use becomes the most important thing in your life.

An alcoholic will continue to drink even when faced with negative consequences, such as losing a job. People with alcohol dependence may know that their alcohol use is causing them and others harm. However, this is often not enough to make the person stop using alcohol.

Sometimes, a person may consume too much alcohol, leading to problems, but he or she is not physically dependent on alcohol. This is known as alcohol abuse.

The cause of alcoholism is still unknown. However, dependency on alcohol develops when you drink so much alcohol that chemical changes in the brain occur. These changes emphasize the pleasurable feelings that result when you drink alcohol. These feelings cause an increased desire to drink, even if it causes harm. Alcoholism typically develops gradually over time.

Although the exact cause of alcoholism is unknown, there are certain factors that may place you at higher risk for developing this disease.

Known risk factors for alcoholism include having:

• more than 15 drinks a week if you are male
• more than 12 drinks a week if you are female
• more than five drinks per occasion at least once a week (binge drinking)
• a parent with alcoholism
• a mental health problem, such as depression, anxiety, or schizophrenia

You may also be at a greater risk for alcoholism if you:

• are a young adult experiencing peer pressure
• have low self-esteem
• experience a high level of stress
• live in a family or culture where alcohol use is common and accepted

Symptoms can be classified based on behaviors and physical outcomes that occur as a result of alcohol addiction.

Alcoholics may engage in the following behaviors:

• drinking alone
• drinking more to feel the effects of alcohol (having a high tolerance)
• becoming violent or hostile when asked about drinking
• neglecting to eat or eating poorly
• neglecting personal hygiene
• missing work or school because of drinking
• being unable to control alcohol intake
• making excuses to drink
• continuing to drink even when legal, social, or economic problems develop

People with alcoholism may also experience the following physical symptoms:

• alcohol cravings
• withdrawal symptoms if drinking is stopped, including shaking, nausea, and vomiting
• tremors in the morning after drinking
• lapses in memory (blacking out) after a night of drinking
• illnesses, such as alcoholic ketoacidosis (includes dehydration-type symptoms) or cirrhosis (scarring) of the liver

Self-Testing: Am I an Alcoholic?

Sometimes it can be hard to draw the line between safe alcohol use and alcohol abuse or dependence. The Mayo Clinic suggests that if you answer yes to any of the following questions, you may have a problem with alcohol:

• If you are male, do you ever have five or more drinks in a day? If you are a woman, do you ever have four or more drinks in a day? (A drink is considered to be 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80 proof liquor.)
• Do you need a drink as soon as you wake up?
• Do you feel guilty about drinking?
• Does it irritate you if others comment on your drinking?
• Do you think it might be better if you cut back on your drinking?

Both the National Council on Alcoholism and Drug Dependence and the Partnership at Drugfree.org both offer more complex tests that can help you assess whether you have an alcohol problem: http://www.ncadd.org/index.php/learn-about-alcohol/alcohol-abuse-self-test and http://www.alcoholscreening.org/

Professional Diagnosis

Alcoholism can be diagnosed by your doctor. If you are exhibiting signs of alcoholism, your doctor will complete a physical exam and ask you questions about your drinking habits.

Your doctor may ask if you:

• drive when you are drunk
• have missed work or have lost a job as a result of your drinking
• need more alcohol to feel “drunk” when you drink
• have experienced blackouts as a result of your drinking
• have tried to cut back on your drinking but could not

Your doctor may also ask to speak with family members about your drinking. Questionnaires to assess alcoholism may also be used by your doctor to diagnose your condition.

Typically, the diagnosis of alcoholism does not require any other type of diagnostic tests. However, your doctor may order blood work to check your liver function if you have signs or symptoms of liver disease. Alcohol abuse can cause serious and lasting damage to your liver as it attempts to filter the alcohol from your bloodstream.

Treatment for alcoholism involves a number of supports that are aimed at helping you refrain from drinking altogether (abstinence). Treatment may occur in stages and can include the following:

• detoxification or withdrawal to rid your body of alcohol
• rehabilitation to learn new coping skills and behaviors
• counseling to address emotional problems that may prompt you to drink
• support, including 12-step programs such as Alcoholics Anonymous
• medical treatment for health problems associated with alcoholism
• medications to help control addiction

There are a couple of different medications that may help with alcohol addiction.

• Naltrexone (ReVia, Vivitrol) is used only after an individual has detoxed from alcohol. This type of drug works by blocking certain receptors in the brain that are associated with the alcoholic “high.” This drug, in combination with counseling, may help to decrease an individual’s craving for alcohol.
• Acamprosate (Campral) is a medication that can help to re-establish the brain’s original chemical state before alcohol dependence. This drug should also be used in conjunction with therapy.
• Disulfiram (Antabuse) is a drug that causes physical discomfort (nausea, vomiting, headaches) any time the individual consumes alcohol.

If your addiction to alcohol is severe, you may need to seek treatment at an inpatient facility. These facilities will provide you with 24-hour care as you withdraw from alcohol and recover from your addiction. Once you are well enough to leave, you will need to continue to receive treatment on an outpatient basis.

Recovery from alcoholism is difficult. Your prognosis will depend on your ability to abstain from alcohol use. Many people who seek treatment for alcoholism will be able to overcome addiction. A strong support system is helpful for making a complete recovery.

Your prognosis will also depend on the health complications that have developed as a result of your drinking. Alcoholism can severely damage your liver. It can also lead to other health complications, including:

• bleeding in the gastrointestinal (GI) tract
• damage to brain cells
• cancer in the GI tract
• dementia (memory loss)
• depression
• high blood pressure
• inflammation of the pancreas (pancreatitis)
• nerve damage
• changes in mental status, including Wernicke-Korsakoff syndrome; this is a degenerative brain disease that causes symptoms such as mental confusion, vision impairment, amnesia, or even coma

You can prevent alcoholism by limiting your alcohol intake. Women should not drink more than one drink per day, and men should not drink more than two drinks per day. If you begin to engage in behaviors that are typical for alcoholics, or if you think that you may have a problem with alcohol, seek the help of your doctor. Also, consider attending a local meeting of Alcoholics Anonymous (AA).