Alcohol problems are now called Alcohol Use Disorders, and include both abuse and dependence. The problems associated with alcohol use are well known. Alcohol is associated with auto accidents, increased violence, loss of jobs, and loss of lives. What makes it possible for most people to have a couple of glasses of wine, beer or hard liquor at a party and stop, while others go on to have serious problems with alcohol?



What are the signs and symptoms of alcohol abuse?

Alcohol abuse is a pattern otherwise known as "problem drinking." The behavioral warning signs of alcohol abuse are:



Drinking excessive amounts of alcohol frequently (The National Institute on Alcohol Abuse and Alcoholism has established two drinks per day for men and one drink a day for women as the limits to safe drinking)

Drinking when it is dangerous (such as driving)

Frequent excessive drinking (known as binge drinking)

Interpersonal difficulties with family, friends, or co-workers

Legal problems related to drinking.

Alcohol abuse may initially be diagnosed in young people who recently began drinking. However, they may also be involved with other drugs, without alcohol being the primary substance they are using. Although some alcohol users abuse alcohol without becoming alcohol-dependent alcoholics, over time abuse may progress to incurable alcoholism.



What is alcoholism (compared to alcohol abuse)?

Alcoholism, also known as alcohol dependence, differs from the alcohol abuse pattern in three critical ways. It is:



chronic

progressive, and

potentially fatal.

The symptoms of alcoholism include those of alcohol abuse plus four serious additional symptoms:



Craving—A strong need, or urge, to drink

Loss of control—Not being able to stop drinking once drinking has begun

Physical dependence—Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping drinking

Tolerance—The need to drink greater amounts of alcohol to get "high."

What are the effects of alcoholism?

Alcoholism is a disease that lasts an addict's lifetime. The consequences of alcoholism are serious. Heavy drinking can cause:



increased risk of cancers of the liver, esophagus, throat, and larynx

liver cirrhosis

immune system problems

brain damage

harm to the fetus during pregnancy (Fetal Alcohol Syndrome) that may impact the child's brain, resulting in learning and behavior problems

male and female incontinence (usually related to cirrhosis)

loss of erectile function, leading to impotence

Denial is an alcoholic's strongest defense mechanism. But even if the alcoholic is quite aware of these serious implications of heavy drinking, the craving that an alcoholic feels for alcohol can be as strong as the need for food or water. An alcoholic will continue to drink despite serious family, health, or legal problems.



People who do not drink or who are alcohol abusers but not alcoholics sometimes do not understand why an alcoholic can't just "exercise a little willpower" to stop drinking. However, alcoholism is an addiction that little to do with willpower. Any addiction has both physical and psychological components that make it extremely difficult to break. Almost all alcoholics need the aid of external treatment to help them succeed in overcoming their addiction.



What causes alcoholism?

People drink in many social situations, but also use alcohol as a means to "self-medicate" other problems, such as stress, anxiety, depression, or mental illnesses. No one who takes a drink thinks he or she will become an alcoholic. While it is not possible to predict whose drinking will lead to alcoholism, there is growing evidence of certain causal factors. The most recent scientific research points to two main areas:



Genetics. Studies conducted among twins and children of alcoholics have shown that genetic factors influence alcoholism and that children of alcoholics are about four times more likely than the general population to develop alcohol problems. Currently, researchers are working to discover the actual genes that put people at risk for alcoholism. Another branch of investigation is into whether there is a specific area of the brain that is different in alcoholics, and whether genetics may also be a factor in this.

Lifestyle. Just because alcoholism tends to run in families does not mean that a child of an alcoholic parent will automatically become an alcoholic, too. While genes partially explain this pattern, more than one-half of all children of alcoholics do not become alcoholic. The risk is higher but other factors may increase the risk for alcoholism:

friends and social activities

the amount of stress in one's life

how readily alcohol is available

role-models (family, friends, or media heroes) who drink

What should you do if you suspect alcohol abuse or alcoholism?

The biggest obstacle to treatment of alcoholism is getting the alcoholic to break through the denial that is a hallmark of this condition, to realize that help is needed. The National Institute on Alcohol Abuse and Alcoholism suggests that you ask the following four questions that can help you find out if you or a loved one has a drinking problem:



Have you ever felt you should cut down on your drinking?

Have people annoyed you by criticizing your drinking?

Have you ever felt bad or guilty about your drinking?

Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

More than one "yes" answer means it is highly likely that a problem exists. If you think that you or someone you know might have an alcohol problem, it is important to see a doctor or other health care provider right away. They can help you determine if a drinking problem exists and plan the best course of action. Among the steps that can be taken are:



Discuss the benefits of stopping your drinking pattern

Set a drinking goal, either abstinence or a limited amount

Examine the social or pressure situations that trigger your drinking

Develop new ways to handle trigger situations so you can maintain your goal

Attend Alcoholics Anonymous meetings for support

Consider Moderation Management (MM), a behavioral change program and national support group network for people who are not alcoholics but who have made the decision to reduce their alcohol consumption. This program is based on the premise that alcohol abuse is a learned behavior (as contrasted with alcohol dependence, which is a disease). For those who are not alcoholics but recognize the need to reduce their alcohol use, MM provides:

a program for problem drinkers that is not abstinence-based

a mutual-help environment to help people cut back on drinking before it becomes a dependency issue

empowerment to take personal responsibility for deciding if moderation or abstinence would be a better individual choice

information about alcohol and moderate drinking guidelines and limits

drink monitoring exercises

goal setting techniques

self-management strategies

If a friend is diagnosed as being an alcoholic but is unwilling to get help, you can't force him or her to do so. However, many alcoholism treatment specialists suggest the following steps to help convince an alcoholic to get treatment:



Stop all cover ups and other "enabling" behaviors (don't try to protect the alcoholic from the results of his or her drinking)

Time your intervention (the best time to talk to the drinker is shortly after an alcohol-related incident has occurred)

Be specific (use examples like the most recent incident to show how his or her drinking has caused problems)

Explain to the drinker what you will do if he or she doesn't seek help (do not make any threats you are not prepared to carry out)

Gather information about local treatment options (if the alcoholic is willing to get help, call immediately for an appointment with a treatment counselor)

How is alcoholism treated?

There is no "one size fits all" treatment for alcoholism. Instead, there are many different treatments that depend on the needs of the individual and the severity of the abuse. Treatments might include:



therapy to help individuals understand their behavior and motivation and improve coping skills

medication to relieve withdrawal symptoms and control cravings

self-help and support groups.

Treatment can be provided in a variety of settings:



medical facility

residential setting (round-the-clock or half-way "sober living"house)

outpatient

Therapy



The three most commonly used behavioral treatments for alcoholism are:



motivation enhancement therapy

cognitive-behavioral therapy, and

12-step facilitation therapy

These treatment options have proven to be effective in reducing alcohol problems and fostering abstinence. One large-scale study found that each of these treatment modalities significantly reduced drinking in the year following treatment. The study also found that about one-third of the study participants who were followed up either were still abstinent or were drinking without serious problems three years after the study ended.



Self-Help Programs



There are a number of self-help programs that help the alcoholic deal with the disease.



Alcoholics Anonymous (AA) is the largest self-help organization:



founded by alcoholics

group meetings facilitated by members

meetings take place on a regular basis daily, at various times, and in many different locations around the world

attendance is voluntary, and membership is free

members are free to attend any of the many meetings held each week

includes support from fellow members who either are struggling or have struggled with the same problem

uses a buddy system ("sponsor") and group intervention to help members when they are tempted to relapse or do relapse

uses the 12-Step Program as guiding principles (developed by the earliest members of Alcoholics Anonymous; adopted and adapted to many other self-help programs)

abstinence-based personal recovery program from the substance or addictive behavior

person admits his or her powerlessness over the substance or behavior

turns his or her fate over to a higher power "as you understand it"

follows steps to examine the effects the behavior has had on his or her life, to accept responsibility for damage caused to others, and to make amends

There are also several non-12-Step programs available, for those who have other interests, special needs, or who object to the "higher power" or "powerlessness" basis of AA:



Secular Organizations for Sobriety (SOS)



a network of independent meetings with an alternative recovery method

promotes abstinence and provides support from others struggling with the same issues

encourages self-empowerment approaches to recovery for those who are uncomfortable with the spiritual content of AA

takes the approach that sobriety is a separate issue from religion or spirituality

credits the individual for achieving and maintaining his or her own sobriety, without reliance on any Higher Power

SMART Recovery (Self Management And Recovery Training)



aims toward abstinence, with focus on self-empowerment, self-reliance, and self-directed change

based on principles of Cognitive-Behavioral Therapy (CBT)

teaches specific tools and techniques within a 4-point program

Enhancing and Maintaining Motivation to Abstain

Coping with Urges

Problem Solving (Managing thoughts, feelings and behaviors)

Lifestyle Balance (Balancing momentary and enduring satisfactions)

Women for Sobriety (WFS)



Founded in 1976, this is the only national organization focusing specifically on the needs of alcoholic women, whose recovery in AA was found to be less successful than for men. Premises and structure are:



the psychological needs are different for women than for men

weekly meetings in small groups of 6-10 women, with a structured format for confidential discussion

based on thirteen positive statements to encourage emotional and spiritual growth, with emphasis on:

positive reinforcement (approval and encouragement).

cognitive strategies (positive thinking).

letting the body help (relaxation techniques, meditation, diet and physical exercise).

Outpatient Treatment



Outpatient treatment refers to treatment that does not require overnight stays in the facility. Treatment can include drug education, individual and group counseling, education groups for caregivers, and case management services. Outpatient treatment varies in the types and intensity of services offered. For example:



night classes

allows a person to maintain a job

requires more personal self-management

intensive outpatient day programs in hospitals

for adults who requires continuity of treatment

becoming a common treatment option

typically 8-hour treatment sessions, including group therapy with emphasis on preventing relapse, managing stress, and communicating with family.

Inpatient Treatment



Inpatient programs involve a stay for detoxification, short-term (a few days to a few weeks), or longer term treatment (a few months to a year or more). They are the choice of treatment for those who:



lack healthy social networks

have not succeeded in outpatient programs

suffer from serious medical or psychological conditions

These facilities provide a structured environment, often based on the 12-step approach, and include alcohol education and different types of therapy (group, individual, and sometimes family or couples therapy). Inpatient treatment is generally in one of two settings:



residential sober-living treatment program

medical facility for alcoholics (especially when medications must be administered and closely monitored)

One randomized study of patients entering employee assistance programs compared inpatient treatment combined with AA with referral to AA alone. This study found that inpatient treatment (a combination of professional treatment and AA) achieved better results for more people than AA alone. Inpatient programs are usually followed up with additional outpatient therapy and participation in AA, or other self-help group.



Finding an appropriate treatment program



Inpatient and outpatient facilities have comparable success rates. The choice of institutional treatment program can be dictated by any of a number of factors, such as:



severity of dependence

availability of facilities

insurance coverage or financial aid

need for detoxification, methadone, or long-term treatment

factors such as age, pregnancy, young children, or need for other medical treatment

need for treatment in language other than English

The Substance Abuse and Mental Health Services Administration (SAMSHA) has an online locator (see Resources, below) that provides a searchable database of private and public facilities that are licensed, certified, or otherwise approved for inclusion by their State substance abuse agency. Search allows for identification of the various factors to be considered in finding a suitable facility.



Relapse

More than 700,000 people receive treatment for alcohol dependence each day. Cutting out alcohol is absolutely necessary for a successful recovery. However, even individuals who are determined to stay sober may suffer one or more slips before achieving long-term sobriety. Research indicates that up to 90% of recovering alcoholics will have a relapse at least one time in the four years following sobriety. While this is a setback, it does not mean that a person cannot recover from alcoholism. That person may well have to restart treatment to enable him or her to again get on the road to long-term and secure sobriety.





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