Alcoholism and alcohol abuse

Causes

There is no known cause of alcohol abuse or alcoholism. Research suggests that certain genes may increase the risk of alcoholism, but which genes and how they work are not known.

How much you drink can influence your chances of becoming dependent. Those at risk for developing alcoholism include:

• Men who have 15 or more drinks a week
• Women who have 12 or more drinks a week
• Anyone who has five 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.

You have an increased risk for alcohol abuse and dependence if you have a parent with alcoholism.

You may also be more likely to abuse alcohol or become dependent if you:

• Are a young adult under peer pressure
• Have depression, bipolar disorder, anxiety disorders, or schizophrenia
• Have easy access to alcohol
• Have low self-esteem
• Have problems with relationships
• Live a stressful lifestyle
• Live in a culture alcohol use is more common and accepted

Alcohol abuse is rising. Around 1 out of 6 people in the United States have a drinking problem.

Symptoms

People who have alcoholism or alcohol abuse often:

• Continue to drink, even when health, work, or family are being harmed
• Drink alone
• Become violent when drinking
• Become hostile when asked about drinking
• Are not able to control drinking -- being unable to stop or reduce alcohol intake
• Make excuses to drink
• Miss work or school, or have a decrease in performance because of drinking
• Stop taking part in activities because of alcohol
• Need to use alcohol on most days to get through the day
• Neglect to eat or eat poorly
• Do not care about or ignore how they dress or whether they are clean
• Try to hide alcohol use
• Shake in the morning or after periods when they have not a drink

Symptoms of alcohol dependence include:

• Memory lapses after heavy drinking
• Needing more and more alcohol to feel "drunk"
• Alcohol withdrawal symptoms when you haven't had a drink for a while
• Alcohol-related illnesses such as alcoholic liver disease

Exams and Tests

The health care provider will perform a physical exam and ask questions about your medical and family history, including use of alcohol.

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

• Do you ever drive when you have been drinking?
• Do you have to drink more than before to get drunk or feel the desired effect?
• Have you felt that you should cut down on your drinking?
• Have you ever had any blackouts after drinking?
• Have you ever missed work or lost a job because of drinking?
• Is someone in your family worried about your drinking?

Tests that may be done include:

• Blood alcohol level (this can tell whether someone has recently been drinking alcohol, but it does not necessarily confirm alcoholism)
• Complete blood count (CBC)
• Liver function tests
• Magnesium blood test

Treatment

Completely stopping the use of alcohol is the ideal goal of treatment. This is called abstinence. A strong social network and family support are important in achieving this.

Completely stopping and avoiding alcohol is difficult for many people with alcoholism. There will be times when it is difficult. You should aim to avoid drinking for as long as possible.

Some people who abuse alcohol may be able to simply reduce the amount they drink. This is called drinking in moderation. If this method does not work, you should try to quit drinking completely.

DECIDING TO QUIT

Many people with alcohol problems do not recognize when their drinking gets out of hand.

The ideal approach to treatment is to help the person realize how much their alcohol use is harming their life and those around them.

Studies find that more people with alcohol problems opt for treatment when their family members or employers are honest with them about their concerns, and try to help them see that drinking is preventing them from reaching their goals.

Withdrawal from alcohol is best done in a controlled, supervised setting. Complications from withdrawal can be life threatening. For more information, see: Alcohol withdrawal

Your health care provider should order blood and urine tests to check for health problems that are common in people who abuse alcohol.

LONG-TERM SUPPORT

Alcohol recovery or support programs can help you stop drinking completely. These programs usually offer:

• Counseling and therapy to discuss alcoholism and its effects and how to control your thoughts and behaviors
• Mental health support
• Medical care

You may be treated in a special recovery center (inpatient), or you may attend a program while you live at home (outpatient).

Medications are sometimes prescribed to prevent you from drinking again.

• Acamprosate is a drug that has been shown to lower relapse rates in those who are alcohol dependent.
• Disulfiram (Antabuse) produces very unpleasant side effects if you drink even a small amount of alcohol within 2 weeks after taking the drug.
• Naltrexone (Vivitrol) decreases alcohol cravings. It is available in an injectable form.

You cannot take these medications if you are pregnant or have certain medical conditions. The medications are often used with long-term treatment with counseling or support groups.

Depression or other mood or anxiety disorders may be noticed after you stop drinking. These should be promptly treated.

It is important that the patient has a living situation that supports their need to avoid alcohol. Some programs offer housing options for people with alcoholism or alcohol abuse.

Support Groups

Support groups are available to help people who are dealing with alcoholism.

ALCOHOLICS ANONYMOUS (AA)

Alcoholics Anonymous (AA) is a self-help group of recovering alcoholics that offers emotional support and specific steps for people recovering from alcohol dependence. The program is commonly called a "12-step" approach. There are local chapters throughout the United States.

AA offers help 24 hours a day and teaches that it is possible to participate in social functions without drinking.

AL-ANON

Family members of a person with an alcohol abuse problem often need counseling. Al-Anon is a support group for partners and others who are affected by someone else's alcoholism.

Alateen provides support for teenage children of people with alcoholism.

OTHER SUPPORT GROUPS

Several other support groups are available.

• SMART recovery teaches you have to change your thoughts and behaviors to help people with alcoholism recover.
• LifeRing recovery and SOS are two nonreligious programs that offer support for people with alcohol abuse.
• Women for Sobriety is a self-help group just for women.
• Moderation Management is a program for those who want to reduce how much they drink. It recommends abstinence for people who cannot do this.

See also: Alcoholism - support group

Outlook (Prognosis)

How well a person with alcoholism or alcohol abuse does depends on whether or not they can stop drinking.

Alcoholism is a major social, economic, and public health problem. Problem drinking can affect every part of a person's life. If you have an alcohol problem, abstinence can help improve your mental and physical health and possibly, your relationships.

Treatment programs can help you quit. However, drinking again after treatment is common. It is important to have a good support system.

Possible Complications

Alcoholism and alcohol abuse can increase your risk of many health problems, including:

• Bleeding in the digestive tract
• Brain cell damage
• Brain disorder called Wernicke-Korsakoff syndrome
• Cancer of the esophagus, liver, colon, and other areas
• Changes in the menstrual cycle (period)
• Delirium tremens (DT's)
• Dementia and memory loss
• Depression and suicide
• Erectile dysfunction
• Heart damage
• High blood pressure
• Inflammation of the pancreas (pancreatitis)
• Liver disease, including cirrhosis
• Nerve damage
• Poor nutrition
• Sleeping problems (insomnia)

Alcohol use also increases your risk for sexually transmitted infections (STIs) and violence.

Drinking alcohol while you are pregnant can lead to severe birth defects in the baby. See: Fetal alcohol syndrome

When to Contact a Medical Professional

Seek immediate medical care or call your local emergency number (such as 911) if:

• You or someone you know has alcohol dependence and develops severe confusion, seizures, or bleeding

Prevention

The National Institute on Alcohol Abuse and Alcoholism recommends:

• Women should not drink more than 1 drink per day
• Men should not drink more than 2 drinks per day

One drink is defined as 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor.

Alternative Names

Alcohol dependence; Alcohol abuse; Problem drinking; Drinking problem

References

Kleber HD, Weiss RD, Anton RF Jr., George TP, Greenfield SF, Kosten TR, et al. Work Group on Substance Use Disorders; American Psychiatric Association; Steering Committee on Practice Guidelines. Treatment of patients with substance use disorders, second edition. Am J Psychiatry. 2007;164:5-123.

In the clinic. Alcohol use. Ann Intern Med. 2009 Mar 3;150(5):

O'Connor PG. Alcohol abuse and dependence. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 31.

Schuckit MA. Alcohol-use disorders. Lancet. 2009;373:492-501.

Update Date: 3/20/2011

Updated by: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.; David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine.