Alcoholism is a chronic disorder most often described as the uncontrolled intake of alcoholic beverages that interferes with physical and mental health, social and familial relationships, and occupational responsibilities. Alcoholism cuts across all social and economic groups, involves both sexes, and occurs at all stages of the life cycle. beginning as early as elementary school age.
Most adults in the United States are light drinkers; a minority – about 10% of the population – account for 50% of all alcohol consumption. About 13% of all adults over age 18 have suffered from alcohol abuse or dependence at some time in their lives. The prevalence of drinking is highest between the ages of 21 and 34, but current statistics show that up to 19% of 12- to 17-year-olds have a serious drinking problem. Males are, two to five times more likely to abuse alcohol than are females. According to some statistics, alcohol abuse is a factor in 60% of all automobile accidents. Alcoholism has no known cure.
Numerous biological, psychological, and sociocultural factors may cause alcohol addiction, but no clear evidence confirms the influence of any of these factors. Family background may playa significant part: An offspring of one alcoholic parent is seven to eight times more likely to become an alcoholic than is a peer without such a parent. Biological factors may include genetic or biochemical abnormalities, nutritional deficiencies, endocrine imbalances, and allergic responses.
Psychological factors may include the urge to drink alcohol to reduce anxiety or symptoms of mental illness; the desire to avoid responsibility in familial, social, and work relationships; and the need to bolster self-esteem.
Sociocultural factors include the availability of alcoholic beverages, group or peer pressure, an excessively stressful lifestyle, and social attitudes that approve frequent imbibing. Advertising supports society’s message that alcohol consumption is part of a healthy lifestyle. Paradoxically, many alcoholics come from families in which alcohol is forbidden.
Signs and symptoms
Most alcoholics deny that they have a drinking problem. Other indications of alcoholism and alcohol abuse include:
- Keeping alcohol in unlikely places at home, at work or in the car
- Gulping drinks, ordering doubles, becoming intoxicated intentionally to feel good or drinking to feel “normal”
- Nausea and vomiting
- Having legal problems or problems with relationships, employment or finances
- Rapid heart rate and sweating
- Restlessness or agitation
Total abstinence is the only effective treatment. Supportive programs that offer detoxification, rehabilitation, and aftercare, including continued involvement in Alcoholics Anonymous (AA), may produce long-term results.
Acute intoxication is treated symptomatically by supporting respiration, preventing aspiration of vomitus, replacing fluids, administering I.V. glucose to prevent hypoglycemia, correcting hypothermia or acidosis, and initiating emergency treatment for trauma, infection, or GI bleeding.
Treatment of chronic alcoholism relies on medications to deter alcohol use and treat effects of withdrawal; psychotherapy, using behavior modification techniques, group therapy, and family therapy; and appropriate measures to relieve associated physical problems.
Aversion, or deterrent, therapy uses a daily oral dose of disulfiram to prevent compulsive drinking. This drug interferes with alcohol metabolism and allows toxic levels of acetaldehyde to accumulate in the patient’s blood, producing immediate and potentially fatal distress if the patient consumes alcohol up to 2 weeks after taking it.
Disulfiram is contraindicated during pregnancy and in patients with diabetes, heart disease, severe hepatic disease, or any disorder in which such a reaction could be especially dangerous. Another form of aversion therapy attempts to induce aversion by administering alcohol with an emetic.
For long-term success with aversion, or deterrent, therapy, the sober alcoholic must learn to fill the place alcohol once occupied in his life with something constructive. For patients with abnormal dependence or for those who also abuse other drugs, aversion therapy with disulfiram may only substitute one drug dependence for another; so it should be used prudently.
Tranquilizers, particularly benzodiazepines, occasionally are used to relieve overwhelming anxiety during rehabilitation. However, these drugs have addictive potential (substituting one substance abuse problem for another), and they can precipitate coma or even death when combined with alcohol. Naltrexone may be useful as an adjunct to psychotherapy, especially when there are high levels of cravings. Antipsychotics are prescribed to control hyperactivity and psychosis. Anticonvulsants, anti emetics, and antidiarrheals also are used to treat symptoms of alcohol withdrawal.
Supportive counseling or individual. group, or family psychotherapy may improve the alcoholic’s ability to cope with stress, anxiety, and frustration and help him gain insight into the personal problems and conflicts that may have led him to alcohol abuse. Ongoing support groups also can help him overcome his dependence on alcohol. In AA, a self-help group with more than a million members worldwide, the alcoholic finds emotional support from others with similar problems. About 40% of AA members stay sober as long as 5 years, and 30% stay sober longer than 5 years.
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 1 drink per day and men no more than 2 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.