Alcoholism

Alcohol is the substance most commonly abused in the United States and the most commonly untreated addiction. Characterized by the compulsive consumption of alcohol despite negative health effects and serious problems with work, personal relationships and finance, alcoholism is a chronic disease that can be fatal if left untreated.

The National Council on Alcoholism and Drug Dependence reports that about 18 million Americans abuse alcohol and that 100,000 Americans die alcohol-related deaths. Almost half of all U.S. traffic deaths are caused in part by alcohol consumption. The number of people who suffer from the disease continues to grow every year despite the growing numbers of alcoholics who seek treatment .

Symptoms of Alcoholism

Because alcohol is legal and socially acceptable, is not as obvious to detect. It is possible for someone to be addicted to alcohol without displaying the usual signs of substance abuse. Alcoholism is different than alcohol abuse. Alcoholism is a disease and is characterized by the following symptoms:

• A compulsion to drink despite other commitments or responsibilities
• Blacking out
• Ritual of drinking
• Irritability if drinking is interrupted
• Hiding alcohol
• Drinking in secret
• Losing interest in other activities
• Drinking drinks in one gulp
• Feeling abnormal without a drink
• A high tolerance to alcohol or the need for multiple drinks to feel relaxed
• Physical withdrawal symptoms when not drinking
• An inability to stop drinking after one drink
• An inability to avoid drinking

Alcoholism is a physical dependence upon alcohol, but there are also genetic factors as well as psychological and social factors that contribute to the disease. Family history, emotional and psychological stress all plays a big part as well as the constant exposure to alcohol. All of these encourage the abuse of alcohol which can lead to alcoholism if it grows unchecked.

Alcohol Addiction Causes

Alcohol addiction — physical dependence on alcohol — occurs gradually as drinking alcohol alters the balance of some chemicals in your brain, such as gamma-aminobutyric acid (GABA), which inhibits impulsiveness, and glutamate, which excites the nervous system. Alcohol also raises the levels of dopamine in the brain, which is associated with the pleasurable aspects of drinking alcohol. Excessive, long-term drinking can deplete or increase the levels of some of these chemicals, causing your body to crave alcohol to restore good feelings or to avoid negative feelings.

Other factors can lead to excessive drinking that contributes to the addiction process. These include:

• Genetics. Certain genetic factors may cause a person to be vulnerable to alcoholism or other addictions.
• Emotional state. High levels of stress, anxiety or emotional pain can lead some people to drink alcohol to block out the turmoil. Certain stress hormones may be associated with alcoholism.
• Psychological factors. Having low-self esteem or depression may make you more likely to abuse alcohol. Having friends or a close partner who drinks regularly — but who may not abuse alcohol — could promote excessive drinking on your part. It may be difficult for you to distance yourself from these "enablers" or at least from their drinking habits.
• Social and cultural factors. The glamorous way that drinking alcohol is portrayed in advertising and in the media may send the message that it's OK to drink excessively.

Alcohol Risk Factors

Steady drinking over time can produce a physical dependence on alcohol. Drinking more than 15 drinks a week for men or 12 drinks a week for women increases the risk of developing dependence on alcohol. However, drinking by itself is just one of the risk factors that contribute to alcoholism. Other risk factors include:

• Age. People who begin drinking at an early age — by age 16 or earlier — are at a higher risk of alcohol dependence or abuse.
• Genetics. Your genetic makeup may increase your risk of alcohol dependency.
• Sex. Men are more likely to become dependent on or abuse alcohol than are women.
• Family history. The risk of alcoholism is higher for people who had a parent or parents who abused alcohol.
• Emotional disorders. Being severely depressed or having anxiety places you at a greater risk of abusing alcohol. Adults with attention-deficit/hyperactivity disorder also may be more likely to become dependent on alcohol.

Alcoholism Treatment

Most people with alcoholism or those who abuse alcohol enter treatment reluctantly because they deny that they have a problem. Health problems or legal difficulties may prompt treatment. Intervention helps some people recognize and accept the need for treatment. If you're concerned about a friend or family member, discuss intervention with a professional.

Various treatments are available to help people with alcohol problems. Depending on the circumstances, treatment may involve an evaluation, a brief intervention, an outpatient program or counseling, or a residential inpatient stay.

The first step in treatment is to determine whether you're alcohol dependent. If you haven't lost control over your use of alcohol, treatment may involve reducing your drinking. If you're dependent on alcohol, simply cutting back is ineffective. Abstinence must be part of your treatment goal.

If you aren't dependent on alcohol but are experiencing the adverse effects of drinking, the goal of treatment is to reduce alcohol-related problems — often through counseling or a brief intervention, which usually involves alcohol-abuse specialists who can establish a specific treatment plan. Interventions may include goal setting, behavioral modification techniques, use of self-help manuals, counseling and follow-up care at a treatment center.

Counseling may take many forms. With cognitive behavior therapy, you and your therapist identify distorted thoughts and beliefs that trigger psychological stress. You learn new ways to view and cope with traumatic events. Emphasis is placed on developing a sense of mastery and control of your thoughts and feelings.

Another option may be aversion therapy, in which drinking alcohol is paired with a strong aversive response — such as nausea or vomiting induced by a medication. After repeated pairing, the alcohol itself causes the aversive response, which decreases the likelihood of relapse.

Residential treatment programs

Many residential alcoholism treatment programs in the United States include abstinence, individual and group therapy, participation in alcoholism support groups, such as Alcoholics Anonymous (AA), educational lectures, family involvement, work assignments, activity therapy and the use of counselors and professional staff experienced in treating alcoholism.

Here is what you might expect from a typical residential treatment program:

• Detoxification and withdrawal. Treatment may begin with a program of detoxification, usually taking about four to seven days. You may need to take sedating medications to prevent delirium tremens or other withdrawal seizures.
• Medical assessment and treatment. Common medical problems related to alcoholism are high blood pressure, increased blood sugar, and liver and heart disease.
• Psychological support and psychiatric treatment. Group and individual counseling and therapy support recovery from the psychological aspects of alcoholism. Many treatment programs also offer couples and family therapy because family support can be an important part of the recovery process. In fact, involving a spouse in the treatment process may increase the chances of successful recovery.
• Emphasis on acceptance and abstinence. Effective treatment is impossible unless you accept that you're addicted and currently unable to control your drinking.
• Drug treatments. An alcohol-sensitizing drug called disulfiram (Antabuse) may be a strong deterrent. Disulfiram won't cure alcoholism nor can it remove the compulsion to drink. But if you drink alcohol, the drug produces a severe physical reaction that includes flushing, nausea, vomiting and headaches. Naltrexone (ReVia), a drug long known to block the narcotic high, also reduces the urge to drink. Acamprosate (Campral) is an anti-craving medication that may help you combat alcohol cravings and remain abstinent from alcohol. Unlike disulfiram, naltrexone and acamprosate don't make you feel sick soon after taking a drink.

In June 2006, the Food and Drug Administration (FDA) approved the first injectable drug to treat alcohol dependence. Vivitrol, a version of the drug naltrexone, is injected in the buttocks once a month by a health care professional. It may reduce the urge to drink by blocking neurotransmitters in the brain thought to be associated with alcohol dependence. Vivitrol doesn't affect alcohol withdrawal symptoms. It's intended for people with alcoholism who are receiving counseling and who haven't had a drink for at least a week. Although similar medication can be taken in pill form, the injectable version of the drug may be easier for people recovering from alcohol dependence to use consistently.