Alcoholism
Basic Information
Alcohol is one of the most widely used -- and one of the most widely abused -- drugs in the world -- and yet there is no precise definition of alcoholism. Alcoholic consumption is high in the United States and it is estimated that there are between 9 and 15 million alcoholics in this country. The lifetime risk for developing this disease is estimated at as high as 10% to 15% in men and 5% in women. In the United States only a third of men are abstainers, while 50% of women are abstainers from alcohol. Blacks and hispanics of both sexes are more likely to abstain from alcohol than whites.
The American Medical Association defines alcoholism as a disease -- a disease which can be arrested but not cured. One of the symptoms is a compulsion to drink -- or an uncontrollable desire to drink -- and as long as an alcoholic continues to drink, the drive or need to drink will only increase, as alcoholism is a progressive disease. And it can result in social, legal, medical illnesses and even in insanity and/or death if it is not arrested. In fact alcohol-related deaths are one of the four most common causes of death in the U.S., accounting for about 5% to 7% of all deaths in this country. Alcoholism accounts for many major illnesses as well, including:
- liver disease (cirrhosis and hepatitis)
- ulcer disease
- esophagitis
- heart disease
- mental disorders
- alcohol dementia
- delirium tremens (DTs)
- alcohol withdrawal delirium
Alcoholism has a tendency to run in families, especially in patients of Irish, Native American or Scandinavian descent. It is believed that social and environmental factors play a role in the disease of alcoholism, but heredity cannot be discounted as a causative factor. Alcoholism tends to run in families on the father's side and the biggest risk is for male relatives of alcoholic men, at least seven times greater than for those of the average individual. Pre-emptive counseling about alcoholism is appropriate and indicated for high risk individuals. Social factors are also thought to play a part in the risk for increased drinking. They include events that are stressors including:
- divorce or break-up
- loss of job
- death or family illness
also:
- depression, recurrent
- broken home
- co-addiction to other substances such as nicotine
As mentioned previously, alcoholism is a progressive disease and even after a long period of sobriety an alcoholic cannot control his/her drinking if they "pick up" (continue their drinking). It is a lifetime disease and the only method of arresting it is total abstinence.
Alcoholism affects all levels of the social strata -- only 3% to 5% are the stereotypical skid-row bums. Most have families, jobs and a network of friends and they function fairly well --- at least for a time. But if an alcoholic continues to drink there will be a growing problem in the alcoholic's life, and family relationships, relationships with friends and the job will begin to suffer. Sometimes there is a slow descent into the maelstrom, with family,, friends and employers turning a blind eye or there can be a more rapid decline in which the alcoholic ceases to function normally and the disease is quite evident and unable to be concealed.
Why do alcoholics drink? As with other substance abusers, they use this drug because they think they have to. In emotional pain, they use alcohol to self-medicate, to escape, in fact to kill the pain. It becomes an obsession to use alcohol, or to depend on alcohol, because they can't imagine getting through life without it. When alcoholics try to give it up, they find withdrawal so painful they go back to using it to kill the misery and pain. Thus they are addicted.
It is the nature of alcoholism that the alcohol abuser denies that there is a drinking problem. The alcoholic dreams of ways to become a social drinker, compulsively tries different ways to control his drinking -- but the scenario is always the same. Truly shocked and surprised at his inability to control his drinking on each new occasion, he finally realizes that he can't. It is beyond his control. When the individual alcohol abuser reaches this conclusion, he may seek help or "give up the ghost". Others may continue to drink, even after realizing their manipulative, compulsive attempts to control their drinking have failed. They may have to hit a more serious "bottom" than self-realization -- such as injury, car accidents, a spouse leaving, loss of employment, or serious illness. Then they may recognize a need for help and can begin the process called recovery. They must have a desire to stop drinking and be able to honestly admit they cannot cope with this devastating problem by themselves. Unfortunately, many alcoholics never reach this stage, do not seek help, and subsequently endure a series of depleting, tortuous events associated with their abusive drinking that can only continue on a downward spiral leading to dementia and death.
Fortunately, today alcoholism is not viewed as the hopeless condition it once was but can be successfully treated in a number of ways, the most effective and best known method being Alcoholics Anonymous (AA).
It is important to remember that alcoholism is a disease as classified by the American Medical Association -- the same as cancer or heart disease -- and is not a willful, controllable or defiant act on the part of the alcoholic. Thus, family members and friends are best served to treat the alcoholic with the same compassion that they would treat a family member diagnosed with any serious illness.
Symptoms
Alcoholism presents many symptoms as it is a threefold disease -- physical, mental and spiritual.
Physical symptoms can include:
- muscle wasting
- periods of malnutrition
- dryness of mouth, alcohol on breath
- infectious diseases (alcohol reduces one's ability to fight infections)
- headaches from hangovers or withdrawal
- vomiting from hangovers or withdrawal
- hepatitis
- gastritis
- pancreatitis
- blackouts (forgetting most or all of what happened during a drinking bout)
- fragmented sleep (lack of deep sleep with nightmares)
- a large amount of time drinking or recovering from drinking
- deterioration of nerves to the hands and feet
Mental symptoms can include:
- continuation of drinking despite physical illness or social problems
- irritability
- abusive behavior
- anxiety from withdrawal
- alcohol related legal problems
- inability to fulfill obligations
Spiritual symptoms can include:
- isolation and withdrawal from interpersonal relationships
- general feeling of malaise or hopelessness
- guilt
- depression (alcohol is a depressant and will only worsen periods of sadness and confusion)
Diagnosis/Treatment
Alcoholism is often considered a self-diagnosed illness -- that is, the patient will often seek help or treatment on his or her own accord. But a health care provider can, by taking a history of alcohol-related life incidents and problems, and by also administering a laboratory test called GGT (an enzyme produced in the liver after having five or more drinks daily) make a diagnosis of alcoholism especially if the GGT shows blood levels of 40 units or more. Questionnaires such as the CAGE survey or Michigan Alcohol Screening Test (MAST) can be used to probe the patient's drinking patterns and be useful tools for diagnosis.
During or immediately after diagnosis a patient should be in a setting created for abstinence so that an examination for alcohol-related health problems (see physical symptoms) can be administered. Often the patient will require detoxification under supervision -- it can be extremely dangerous to suddenly stop drinking after persistent intake of alcohol. Delirium tremens (DTs) can occur and even fatal seizures. Drugs such as the benzodiazeprines (Valium, librium, etc.) should be administered as the patient is weaned off alcohol, as well as vitamins such as folic acid. Sometimes drugs are recommended following detoxification such as naltrexone to reduce initial cravings for alcohol or disulfiram (antabuse) to interact with alcohol a patient may imbibe so that unpleasant physical symptoms occur. But antabuse use is controversial in that it may relieve the patient of responsibility for change as well as having potential contributions to liver failure..
The first goal of treatment should be to stabilize threatening medical problems then to motivate the patient towards recovery (see Alcoholism--Recovery). Abstinence, detoxification, education, motivation then rehabilitation in peer support groups has met with success in treatment of alcoholism.
Alcoholics Anonymous (AA) has proved to be a remarkable success in helping the alcoholic maintain sobriety. AA is a 12-step recovery program in which the recovering alcoholic attends meetings on a regular basis in which he or she is invited to share experience, strength and hope with other recovering alcoholics who admit their powerlessness over alcohol and begin the journey to spiritual health. AA has been the successful model for other 12-step programs for substance abuse and process addictions.
If you feel you have a drinking problem or if someone you care about has a drinking problem, please contact a non-judgmental compassionate health care professional who is knowledgeable about alcoholism. Alcoholism is a serious illness -- but many alcoholics become abstinent and maintain sobriety. There is much hope for the alcoholic. But should the alcoholic continue to drink the alcoholic's lifespan will be shortened by an average of 15 years with the causes of death being (in order): a) heart disease; b) cancer; c) accidents; d) suicide.
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