Alternate Names: Alcohol dependence; Habitual alcohol use

Causes and Risks:

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 low level of alcohol within the body slows reactions. Concentration and judgment become impaired. In excessive amounts, intoxication or poisoning results.

Alcohol also affects other body systems. Irritation of the gastrointestinal tract can occur with erosion of the lining of the stomach causing nausea and vomiting. Vitamins are not absorbed properly, which can lead to nutritional deficiencies with the long-term use of alcohol. Liver disease, called hepatic cirrhosis, may also develop. The cardiovascular system may be affected by cardiomyopathy. Sexual dysfunction can also occur, causing erectile dysfunction in men and cessation of menses 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 problems in the developing fetus known as fetal alcohol syndrome, which may result in mental retardation of the child.

The social consequences of problem drinking and alcohol dependence can be as serious as the medical problems. People who abuse alcohol have a higher incidence of unemployment, domestic violence, and difficulty with the law. About half of all traffic fatalities are related to alcohol use.

The development of dependence upon 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 relating to drinking episodes may follow tolerance. Then a lack of control over drinking occurs, and the affected person can no longer discontinue drinking whenever desired. 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.

When a person who is physically dependent on alcohol tries to stop, a withdrawal syndrome develops, with symptoms that may include elevated temperature, increased blood pressure, rapid heart rate, restlessness, anxiety, psychosis, seizures, and rarely even death.

There is no definite 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. The reason for this occurrence is not known, but genetic or biochemical abnormalities may be present. 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.

Incidence of alcohol dependence is increasing. Statistics vary, but approximately 7% of adults in the United States are affected.

Prevention:

Educational programs and medical advice about alcohol abuse has been successful in decreasing problem drinking 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.

Symptoms:

At-risk drinkers are men who consumes 15 or more drinks a week, women who consume 12 or more drinks a week, or anyone who consumes 5 or more drinks per occasion at least once a week. (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).

The following questions are used by the National Institute on Alcohol Abuse and Alcoholism to screen for alcohol abuse:

• Have you ever thought you had an alcohol problem?
• Do you ever drive when drinking?
• Is someone in your family concerned about your drinking?
• Have you ever had any blackouts after drinking?
• Have you ever been absent from work or lost a job because of drinking?
• Does it take more drinks than it used to achieve the desired effect (tolerance)?

Other symptoms associated with alcoholism include

• solitary drinking
• making excuses to drink
• need for daily or frequent use of alcohol for adequate function
• lack of control over drinking, with inability to discontinue or reduce alcohol intake
• episodes of violence associated with drinking
• secretive behavior to hide alcohol related behavior
• hostility when confronted about drinking
• neglect of food intake
• neglect of physical appearance
• nausea and vomiting
• shaking in the morning
• abdominal pain
• numbness and tingling
• confusion

Note: Symptoms may vary.

Alcohol withdrawal symptoms may vary from mild to severe:

• rapid heart rate and sweating
• restlessness, agitation, or confusion
• loss of appetite, nausea, or vomiting
• confusion of hallucinations
• tremors and seizures

Signs and Tests:

There is a history of chronic and excessive alcohol use. 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:

Alcohol dependency usually requires treatment programs that include medical supervision and counseling. The person with alcohol dependence often has little recognition of the problem. Alcoholism is associated with denial, allowing the person to believe there is no need for treatment. The person should be confronted when sober, not while drinking or recovering from a drinking episode. Often people enter treatment only after their family, doctor, or the legal system pressures them. Once the problem has been recognized, total abstinence from alcohol is required. Programs are available to offer detoxification, rehabilitation, and aftercare or follow-up. Because alcoholism creates victims of people associated closely with the alcoholic, 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. Liver disease 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). 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 is recovered 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 with 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.

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. 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

Go to the emergency room or call the local emergency number (such as 911) if severe confusion, seizures, bleeding, or other health problems develop in a person known or suspected to have alcohol dependence.