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Alcoholism

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Alcoholism
Classification and external resources

"King Alcohol and his Prime Minister" circa 1820


ICD-10 F10..2
ICD-9 303
MedlinePlus alcoholism
MeSH D000437
Alcoholism is a disabling addictive disorder. It is characterized by compulsive and uncontrolled
consumption of alcohol despite its negative effects on the drinker's health, relationships, and
social standing. Like other drug addictions, alcoholism is medically defined as a treatable
disease.[1] The term alcoholism is widely used, and was first coined in 1849 by Magnus Huss, but
in medicine the term was replaced by the concepts of "alcohol abuse" and "alcohol dependence"
in the 1980s DSM III.[2] (The term alcohol dependence is sometimes used as a synonym for
alcoholism,[3][4] sometimes in a narrower sense.) Similarly in 1979 an expert World Health
Organisation committee disfavoured the use of "alcoholism" as a diagnostic entity, preferring the
category of "alcohol dependence syndrome".[5] In the nineteenth and early twentieth centuries,
alcohol dependence was called dipsomania before the term "alcoholism" replaced it.[6]
The biological mechanisms underpinning alcoholism are uncertain, however, risk factors include
social environment, stress,[7] mental health, genetic predisposition, age, ethnic group, and sex.[8][9]
Long-term alcohol abuse produces physiological changes in the brain such as tolerance and
physical dependence. Such brain chemistry changes maintain the alcoholic's compulsive inability
to stop drinking and result in alcohol withdrawal syndrome upon discontinuation of alcohol
consumption.[10] Alcohol damages almost every organ in the body, including the brain; because
of the cumulative toxic effects of chronic alcohol abuse, the alcoholic risks suffering a range of
medical and psychiatric disorders.[11] Alcoholism has profound social consequences for
alcoholics and the people of their lives.[12][13]
Alcoholism is the cyclic presence of tolerance, withdrawal, and excessive alcohol use; the
drinker's inability to control such compulsive drinking, despite awareness of its harm to his or
her health, indicates that the person might be an alcoholic.[14] Questionnaire-based screening is a
method of detecting harmful drinking patterns, including alcoholism.[15] Alcohol detoxification is
conducted to withdraw the alcoholic person from drinking alcohol, usually with cross-tolerance
drugs, e.g. benzodiazepines to manage withdrawal symptoms.[16] Post-medical care, such as
group therapy, or self-help groups, usually is required to maintain alcoholic abstention.[17][18]
Often, alcoholics also are addicted to other drugs, most often benzodiazepines, which might
require additional medical treatment.[19] The alcoholic woman is more sensitive to alcohol's
deleterious physical, cerebral, and mental effects, and increased social stigma, in relation to a
man, for being an alcoholic.[20][21] The World Health Organisation estimates that there are 140
million alcoholics worldwide.[22][23] Moderate use is defined by The Dietary Guidelines for
Americans as no more than two alcoholic beverages per day for men and no more than one
alcoholic beverage per day for women.[24]
The term "alcoholism" is commonly used, but poorly defined. The WHO calls alcoholism "a
term of long-standing use and variable meaning", and use of the term was disfavored by a 1979
WHO Expert Committee. The Big Book (from Alcoholics Anonymous) states that once a person
is an alcoholic, they are always an alcoholic, but does not define what is meant by the term
"alcoholic" in this context. In 1960, Bill W., co-founder of AA, said:
We have never called alcoholism a disease because, technically speaking, it is not a
disease entity. For example, there is no such thing as heart disease. Instead there are
many separate heart ailments, or combinations of them. It is something like that with
alcoholism. Therefore we did not wish to get in wrong with the medical profession by
pronouncing alcoholism a disease entity. Therefore we always called it an illness, or a
malady -- a far safer term for us to use.[25]
In professional and research contexts, the term "alcoholism" sometimes encompasses both
alcohol abuse and alcohol dependence.[26] and sometimes is considered equivalent to alcohol
dependence.
In psychology and psychiatry, the DSM is the most common global standard, while in medicine,
the standard is ICD. The terms they recommend are similar but not identical:
Organization Preferred term(s) Definition
• alcohol abuse = repeated use despite recurrent adverse
consequences.[27]
• alcohol dependence = alcohol abuse combined with
tolerance, withdrawal, and an uncontrollable drive to
"alcohol abuse" drink.[27]
APA's DSM-
and "alcohol The term "alcoholism" was split into "alcohol abuse" and
IV
dependence" "alcohol dependence" in 1980's DSM-III, and in 1987's DSM-
III-R behavioral symptoms were moved from "abuse" to
"dependence".[2] It has been suggested that DSM-V merge
alcohol abuse and alcohol dependence into a single new entry,
[28]
named "alcohol-use disorder".[29]
Definitions are similar to that of the DSM-IV. The World
Health Organisation uses the term alcohol dependence
"alcohol harmful
syndrome rather than alcoholism.[5] The concept of "harmful
WHO's ICD- use" and "alcohol
use" (as opposed to "abuse") was introduced in 1992's ICD-10
10 dependence
to minimize underreporting of damage in the absence of
syndrome"
dependence.[2] The term "alcoholism" was removed from ICD
between ICD-8/ICDA-8 and ICD-9.[30]
Despite the imprecision inherent in the term, there have been attempts to define how the word
"alcoholism" should be interpreted when encountered. In 1992, it was defined by the NCADD
and ASAM as "a primary, chronic disease characterized by impaired control over drinking,
preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and
distortions in thinking."[31] MeSH has had an entry for "alcoholism" since 1999, and references
the 1992 definition.[32]

Contents
[hide]
• 1 Etymology
• 2 Signs and symptoms
○ 2.1 Symptoms of long term alcohol misuse
 2.1.1 Physical symptoms
 2.1.2 Psychiatric symptoms
 2.1.3 Social effects
○ 2.2 Alcohol withdrawal
• 3 Causes
○ 3.1 Genetic variation
• 4 Pathophysiology
• 5 Diagnosis
○ 5.1 Social barriers
○ 5.2 Screening
○ 5.3 Genetic predisposition testing
○ 5.4 DSM diagnosis
○ 5.5 Urine and blood tests
• 6 Prevention
• 7 Management
○ 7.1 Detoxification
○ 7.2 Group therapy and psychotherapy
○ 7.3 Rationing and moderation
○ 7.4 Medications
○ 7.5 Dual addictions
• 8 Epidemiology
• 9 Prognosis
• 10 History
• 11 Society and culture
• 12 See also
• 13 References
• 14 Further reading
• 15 External links

[edit] Etymology
1904 advertisement describing alcoholism as a disease.
Historically the name dipsomania was coined by German physician Dr. C. W. Hufeland in 1819
before it was superseded by alcoholism.[33][34] The term "alcoholism" was first used in 1849 by
the Swedish physician Magnus Huss to describe the systematic adverse effects of alcohol.[35]
AA describes alcoholism as an illness that involves a physical allergy[36]:p.28 and a mental
obsession.[36]:p.23[37] Note that the definition of "allergy" used in this context is not the same as
used in modern medicine.[38] The doctor and addiction specialist Dr. William D. Silkworth M.D.
writes on behalf of AA that "Alcoholics suffer from a "(physical) craving beyond mental
control".[36]:XXVI
A 1960 study by E. Morton Jellinek is considered the foundation of the modern disease theory of
alcoholism.[39] Jellinek's definition restricted the use of the word "alcoholism" to those showing a
particular natural history. The modern medical definition of alcoholism has been revised
numerous times since then. The American Medical Association currently uses the word
alcoholism to refer to a particular chronic primary disease.[40]
A minority opinion within the field, notably advocated by Herbert Fingarette and Stanton Peele,
argue against the existence of alcoholism as a disease. Critics of the disease model tend to use
the term "heavy drinking" when discussing the negative effects of alcohol consumption.
[edit] Signs and symptoms
[edit] Symptoms of long term alcohol misuse
Main article: Long-term effects of alcohol
Alcoholism is characterised by an increased tolerance of and physical dependence on alcohol,
affecting an individual's ability to control alcohol consumption safely. These characteristics are
believed to play a role in impeding an alcoholic's ability to stop drinking.[10] Alcoholism can have
adverse effects on mental health, causing psychiatric disorders to develop and an increased risk
of suicide.[41][42]
[edit] Physical symptoms

Some of the possible long-term effects of ethanol an individual may develop. Additionally, in
pregnant women, alcohol can cause fetal alcohol syndrome.
Long term alcohol abuse can cause a number of physical symptoms, including cirrhosis of the
liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, nutritional
deficiencies, and sexual dysfunction, and can eventually be fatal. Other physical effects include
an increased risk of developing cardiovascular disease, malabsorption, alcoholic liver disease,
and cancer. Damage to the central nervous system and peripheral nervous system can occur from
sustained alcohol consumption.[43][44]
Women develop long-term complications of alcohol dependence more rapidly than do men.
Additionally, women have a higher mortality rate from alcoholism than men.[20] Examples of
long term complications include brain, heart, and liver damage[21] and an increased risk of breast
cancer. Additionally, heavy drinking over time has been found to have a negative effect on
reproductive functioning in women. This results in reproductive dysfunction such as anovulation,
decreased ovarian mass, problems or irregularity of the menstrual cycle, and early menopause.[20]
Alcoholic ketoacidosis can occur in individuals who chronically abuse alcohol and have a recent
history of binge drinking.[45][46]
[edit] Psychiatric symptoms
Long term misuse of alcohol can cause a wide range of mental health problems. Severe cognitive
problems are not uncommon; approximately 10 percent of all dementia cases are related to
alcohol consumption, making it the second leading cause of dementia.[47] Excessive alcohol use
causes damage to brain function, and psychological health can be increasingly affected over
time.[48]
Psychiatric disorders are common in alcoholics, with as many as 25 percent suffering severe
psychiatric disturbances. The most prevalent psychiatric symptoms are anxiety and depression
disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically
improve or disappear with continued abstinence.[49] Psychosis, confusion, and organic brain
syndrome may be caused by alcohol misuse, which can lead to a misdiagnosis such as
schizophrenia.[50] Panic disorder can develop or worsen as a direct result of long term alcohol
misuse.[51][52]
The co-occurrence of major depressive disorder and alcoholism is well documented.[53][54][55]
Among those with comorbid occurrences, a distinction is commonly made between depressive
episodes that remit with alcohol abstinence ("substance-induced"), and depressive episodes that
are primary and do not remit with abstinence ("independent" episodes).[56][57][58] Additional use of
other drugs may increase the risk of depression.[59]
Psychiatric disorders differ depending on gender. Women who have alcohol-use disorders often
have a co-occurring psychiatric diagnosis such as major depression, anxiety, panic disorder,
bulimia, post-traumatic stress disorder (PTSD), or borderline personality disorder. Men with
alcohol-use disorders more often have a co-occurring diagnosis of narcissistic or antisocial
personality disorder, bipolar disorder, schizophrenia, impulse disorders or attention
deficit/hyperactivity disorder.[60] Women with alcoholism are more likely to have a history of
physical or sexual assault, abuse and domestic violence than those in the general population,[60]
which can lead to higher instances of psychiatric disorders and greater dependence on alcohol.
[edit] Social effects
See also: Drug-related crime
The social problems arising from alcoholism are serious, caused by the pathological changes in
the brain and the intoxicating effects of alcohol.[47][61] Alcohol abuse is associated with an
increased risk of committing criminal offences, including child abuse, domestic violence, rape,
burglary and assault.[62] Alcoholism is associated with loss of employment,[63] which can lead to
financial problems. Drinking at inappropriate times, and behavior caused by reduced judgment,
can lead to legal consequences, such as criminal charges for drunk driving[13] or public disorder,
or civil penalties for tortious behavior, and may lead to a criminal sentence.
An alcoholic's behavior and mental impairment, while drunk, can profoundly impact those
surrounding them and lead to isolation from family and friends. This isolation can lead to marital
conflict and divorce, or contribute to domestic violence. Alcoholism can also lead to child
neglect, with subsequent lasting damage to the emotional development of the alcoholic's
children.[12]
[edit] Alcohol withdrawal
Main article: Alcohol withdrawal syndrome
As with similar substances with a sedative-hypnotic mechanism, such as barbiturates and
benzodiazepines, withdrawal from alcohol dependence can be fatal if it is not properly managed.
[61][64]
Alcohol's primary effect is the increase in stimulation of the GABAA receptor, promoting
central nervous system depression. With repeated heavy consumption of alcohol, these receptors
are desensitized and reduced in number, resulting in tolerance and physical dependence. When
alcohol consumption is stopped too abruptly, the person's nervous system suffers from
uncontrolled synapse firing. This can result in symptoms that include anxiety, life threatening
seizures, delirium tremens, hallucinations, shakes and possible heart failure.[65][66] Other
neurotransmitter systems are also involved, especially dopamine, NMDA and glutamate.[10][67]
Acute withdrawal symptoms tend to subside after one to three weeks. Less severe symptoms
(e.g. insomnia and anxiety, anhedonia) may continue as part of a post withdrawal syndrome
gradually improving with abstinence for a year or more.[68][69][70] Withdrawal symptoms begin to
subside as the body and central nervous system restore alcohol tolerance and GABA functioning
towards normal.[71][72]
[edit] Causes
A complex mixture of genetic and environmental factors influence the risk of the development of
alcoholism.[73] Genes which influence the metabolism of alcohol also influence the risk of
alcoholism, and may be indicated by a family history of alcoholism.[74] One paper has found that
alcohol use at an early age may influence the expression of genes which increase the risk of
alcohol dependence.[75] Individuals who have a genetic disposition to alcoholism are also more
likely to begin drinking at an earlier age than average.[76] Also, a younger age of onset of drinking
is associated with an increased risk of the development of alcoholism,[76] and about 40 percent of
alcoholics will drink excessively by their late adolescence. It is not entirely clear whether this
association is causal, and some researchers have been known to disagree with this view.[77]
Severe childhood trauma is also associated with an general increase in the risk of drug
dependency.[73] Lack of peer and family support is associated with a increased risk of alcoholism
developing.[73] Genetics and adolescence are associated with an increased sensitivity to the
neurotoxic effects of chronic alcohol abuse. Cortical degeneration due to the neurotoxic effects
increases impulsive behaviour, which may contribute to the development, persistence and
severity of alcohol use disorders. There is evidence that with abstinence, there is a reversal of at
least some of the alcohol induced central nervous system damage.[78]
[edit] Genetic variation
See also: Human genetic variation
Genetic differences exist between different racial groups which affect the risk of developing
alcohol dependence. For example, there are differences between African, East Asian and Indo-
racial groups in how they metabolize alcohol. These genetic factors are believed to, in part,
explain the differing rates of alcohol dependence among racial groups.[79][80] The alcohol
dehydrogenase allele ADH1 B*3 causes a more rapid metabolism of alcohol. The allele ADH1
B*3 is only found in those of African descent and certain Native American tribes. African and
native Americans with this allele have a reduced risk of developing alcoholism.[81] Native
Americans however, have a significantly higher rate of alcoholism than average; it is unclear
why this is the case.[82] Other risk factors such as cultural environmental effects e.g. trauma have
been proposed to explain the higher rates of alcoholism among Native Americans compared to
alcoholism levels in caucasians.[83][84]
[edit] Pathophysiology
Alcohol's primary effect is the increase in stimulation of the GABAA receptor, promoting central
nervous system depression. With repeated heavy consumption of alcohol, these receptors are
desensitized and reduced in number, resulting in tolerance and physical dependence.[65] The
amount of alcohol that can be biologically processed and its effects differ between sexes. Equal
dosages of alcohol consumed by men and women generally result in women having higher blood
alcohol concentrations (BACs).[60] This can be attributed to many reasons, the main being that
women have less body water than men. A given amount of alcohol, therefore becomes more
highly concentrated in a woman's body. A given amount of alcohol causes greater intoxication
for women due to different hormone release compared to men.[21]
[edit] Diagnosis
See also: Addiction medicine
[edit] Social barriers
Attitudes and social stereotypes can create barriers to the detection and treatment of alcohol
abuse. This is more of a barrier for women than men. Fear of stigmatization may lead women to
deny that they are suffering from a medical condition, to hide their drinking, and to drink alone.
This pattern, in turn, leads family, physicians, and others to be less likely to suspect that a
woman they know is an alcoholic.[20] In contrast, reduced fear of stigma may lead men to admit
that they are suffering from a medical condition, to publicly display their drinking, and to drink
in groups. This pattern, in turn, leads family, physicians, and others to be more likely to suspect
that a man they know is an alcoholic.[60]
[edit] Screening
Several tools may be used to detect a loss of control of alcohol use. These tools are mostly self
reports in questionnaire form. Another common theme is a score or tally that sums up the general
severity of alcohol use.[15]
The CAGE questionnaire, named for its four questions, is one such example that may be used to
screen patients quickly in a doctor's office.
Two "yes" responses indicate that the respondent should be investigated further. The
questionnaire asks the following questions:
1. Have you ever felt you needed to Cut down on your drinking?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt Guilty about drinking?
4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to
steady your nerves or to get rid of a hangover?[85][86]
The CAGE questionnaire has demonstrated a high effectiveness in detecting alcohol
related problems; however, it has limitations in people with less severe alcohol related
problems, white women and college students.[87]
Other tests are sometimes used for the detection of alcohol dependence, such as the Alcohol
Dependence Data Questionnaire, which is a more sensitive diagnostic test than the CAGE
questionnaire. It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol
use.[88] The Michigan Alcohol Screening Test (MAST) is a screening tool for alcoholism widely
used by courts to determine the appropriate sentencing for people convicted of alcohol-related
offenses,[89] driving under the influence being the most common. The Alcohol Use Disorders
Identification Test (AUDIT), a screening questionnaire developed by the World Health
Organization, is unique in that it has been validated in six countries and is used internationally.
Like the CAGE questionnaire, it uses a simple set of questions – a high score earning a deeper
investigation.[90] The Paddington Alcohol Test (PAT) was designed to screen for alcohol related
problems amongst those attending Accident and Emergency departments. It concords well with
the AUDIT questionnaire but is administered in a fifth of the time.[91]
[edit] Genetic predisposition testing
Psychiatric geneticists John I. Nurnberger, Jr., and Laura Jean Bierut suggest that alcoholism
does not have a single cause—including genetic—but that genes do play an important role "by
affecting processes in the body and brain that interact with one another and with an individual's
life experiences to produce protection or susceptibility". They also report that fewer than a dozen
alcoholism-related genes have been identified, but that more likely await discovery.[92]
At least one genetic test exists for an allele that is correlated to alcoholism and opiate addiction.
[93]
Human dopamine receptor genes have a detectable variation referred to as the DRD2 TaqI
polymorphism. Those who possess the A1 allele (variation) of this polymorphism have a small
but significant tendency towards addiction to opiates and endorphin-releasing drugs like alcohol.
[94]
Although this allele is slightly more common in alcoholics and opiate addicts, it is not by
itself an adequate predictor of alcoholism, and some researchers argue that evidence for DRD2 is
contradictory.[92]
[edit] DSM diagnosis
The DSM-IV diagnosis of alcohol dependence represents one approach to the definition of
alcoholism. In part this is to assist in the development of research protocols in which findings
can be compared to one another. According to the DSM-IV, an alcohol dependence diagnosis is:
[14]

... maladaptive alcohol use with clinically significant impairment as manifested by at least three
of the following within any one-year period: tolerance; withdrawal; taken in greater amounts or
over longer time course than intended; desire or unsuccessful attempts to cut down or control
use; great deal of time spent obtaining, using, or recovering from use; social, occupational, or
recreational activities given up or reduced; continued use despite knowledge of physical or
psychological sequelae.
[edit] Urine and blood tests
There are reliable tests for the actual use of alcohol, one common test being that of blood alcohol
content (BAC).[95] These tests do not differentiate alcoholics from non-alcoholics; however, long-
term heavy drinking does have a few recognizable effects on the body, including:[96]
• Macrocytosis (enlarged MCV)
• Elevated GGT
• Moderate elevation of AST and ALT and an AST: ALT ratio of 2:1
• High carbohydrate deficient transferrin (CDT)
However, none of these blood tests for biological markers is as sensitive as screening
questionnaires.
[edit] Prevention
The World Health Organization, the European Union and other regional bodies, national
governments and parliaments have formed alcohol policies in order to reduce the harm of
alcoholism.[97][98] Targeting adolescents and young adults is regarded as an important step to
reduce the harm of alcohol abuse. Increasing the age at which licit drugs of abuse such as alcohol
can be purchased, the banning or restricting advertising of alcohol has been recommended as
additional ways of reducing the harm of alcohol dependence and abuse. Credible, evidence based
educational campaigns in the mass media about the consequences of alcohol abuse have been
recommended. Guidelines for parents to prevent alcohol abuse amongst adolescents, and for
helping young people with mental health problems have also been suggested.[99]
[edit] Management
Treatments are varied because there are multiple perspectives of alcoholism. Those who
approach alcoholism as a medical condition or disease recommend differing treatments than, for
instance, those who approach the condition as one of social choice. Most treatments focus on
helping people discontinue their alcohol intake, followed up with life training and/or social
support in order to help them resist a return to alcohol use. Since alcoholism involves multiple
factors which encourage a person to continue drinking, they must all be addressed in order to
successfully prevent a relapse. An example of this kind of treatment is detoxification followed by
a combination of supportive therapy, attendance at self-help groups, and ongoing development of
coping mechanisms. The treatment community for alcoholism typically supports an abstinence-
based zero tolerance approach; however, there are some who promote a harm-reduction approach
as well.[100]
[edit] Detoxification
Main article: Alcohol detoxification
Alcohol detoxification or 'detox' for alcoholics is an abrupt stop of alcohol drinking coupled with
the substitution of drugs, such as benzodiazepines, that have similar effects to prevent alcohol
withdrawal. Individuals who are only at risk of mild to moderate withdrawal symptoms can be
detoxified as outpatients. Individuals at risk of a severe withdrawal syndrome as well as those
who have significant or acute comorbid conditions are generally treated as inpatients.
Detoxification does not actually treat alcoholism, and it is necessary to follow-up detoxification
with an appropriate treatment program for alcohol dependence or abuse in order to reduce the
risk of relapse.[16]
[edit] Group therapy and psychotherapy

A regional service center for Alcoholics Anonymous.


Various forms of group therapy or psychotherapy can be used to deal with underlying
psychological issues that are related to alcohol addiction, as well as provide relapse prevention
skills. The mutual-help group-counseling approach is one of the most common ways of helping
alcoholics maintain sobriety.[17][18] Alcoholics Anonymous was one of the first organizations
formed to provide mutual, nonprofessional counseling, and it is still the largest. Others include
LifeRing Secular Recovery, SMART Recovery, and Women For Sobriety.
[edit] Rationing and moderation
Rationing and moderation programs such as Moderation Management and DrinkWise do not
mandate complete abstinence. While most alcoholics are unable to limit their drinking in this
way, some return to moderate drinking. A 2002 U.S. study by the National Institute on Alcohol
Abuse and Alcoholism (NIAAA) showed that 17.7 percent of individuals diagnosed as alcohol
dependent more than one year prior returned to low-risk drinking. This group, however, showed
fewer initial symptoms of dependency.[101] A follow-up study, using the same subjects that were
judged to be in remission in 2001–2002, examined the rates of return to problem drinking in
2004–2005. The study found abstinence from alcohol was the most stable form of remission for
recovering alcoholics.[102] A long-term (60 year) follow-up of two groups of alcoholic men
concluded that "return to controlled drinking rarely persisted for much more than a decade
without relapse or evolution into abstinence."[103]
[edit] Medications
A variety of medications may be prescribed as part of treatment for alcoholism.
Medications currently in use
• Antabuse (disulfiram) prevents the elimination of acetaldehyde, a chemical the body
produces when breaking down ethanol. Acetaldehyde itself is the cause of many
hangover symptoms from alcohol use. The overall effect is severe discomfort when
alcohol is ingested: an extremely fast-acting and long-lasting uncomfortable hangover.
This discourages an alcoholic from drinking in significant amounts while they take the
medicine. A recent nine-year study found that incorporation of supervised disulfiram and
the related compound carbamide into a comprehensive treatment program resulted in an
abstinence rate of over 50 percent.[104]
• Temposil (calcium carbimide) works in the same way as Antabuse; it has an advantage in
that the occasional adverse effects of disulfiram, hepatotoxicity and drowsiness, do not
occur with calcium carbimide.[104][105]
• Naltrexone is a competitive antagonist for opioid receptors, effectively blocking the
effects of endorphins and opiates. Naltrexone is used to decrease cravings for alcohol and
encourage abstinence. Alcohol causes the body to release endorphins, which in turn
release dopamine and activate the reward pathways; hence when naltrexone is in the body
there is a reduction in the pleasurable effects from consuming alcohol.[106] Naltrexone is
also used in an alcoholism treatment method called the Sinclair Method, which treats
patients through a combination of Naltrexone and continued drinking.[107]
• Campral (acamprosate) stabilises the brain chemistry that is altered due to alcohol
dependence via antagonising the actions of glutamate, a neurotransmitter which is
hyperactive in the post-withdrawal phase.[108] A 2010 review of medical studies
demonstrated that acamprosate reduces the incidence of relapse amongst alcohol
dependent persons.[109]
Experimental medications
• Topamax (topiramate), a derivative of the naturally occurring sugar monosaccharide D-
fructose, has been found effective in helping alcoholics quit or cut back on the amount
they drink. Evidence suggests that topiramate antagonizes excitatory glutamate receptors,
inhibits dopamine release, and enhances inhibitory gamma-aminobutyric acid function. A
2008 review of the effectiveness of topiramate concluded that the results of published
trials are promising, however as of 2008, data was insufficient to support using
topiramate in conjunction with brief weekly compliance counseling as a first-line agent
for alcohol dependence.[110] A 2010 review found that topiramate may be superior to
existing alcohol pharmacotherapeutic options. Topiramate effectively reduces craving
and alcohol withdrawal severity as well as improving quality-of-life-ratings.[111]
Medications which may worsen outcome
• Benzodiazepines, whilst useful in the management of acute alcohol withdrawal, if used
long-term cause a worse outcome in alcoholism. Alcoholics on chronic benzodiazepines
have a lower rate of achieving abstinence from alcohol than those not taking
benzodiazepines. This class of drugs are commonly prescribed to alcoholics for insomnia
or anxiety management.[112] Initiating prescriptions of benzodiazepines or sedative-
hypnotics in individuals in recovery has a high rate of relapse with one author reporting
more than a quarter of people relapsed after being prescribed sedative-hypnotics. Patients
often mistakenly think that they are sober despite continuing to take benzodiazepines.
Those who are long-term users of benzodiazepines should not be withdrawn rapidly, as
severe anxiety and panic may develop, which are known risk factors for relapse into
alcohol abuse. Taper regimes of 6–12 months have been found to be the most successful,
with reduced intensity of withdrawal.[113][114]
[edit] Dual addictions
Alcoholics may also require treatment for other psychotropic drug addictions. The most common
dual addiction in alcohol dependence is a benzodiazepine dependence, with studies showing 10–
20 percent of alcohol-dependent individuals had problems of dependence and/or misuse
problems of benzodiazepines. Benzodiazepines increase cravings for alcohol and the volume of
alcohol consumed by problem drinkers.[115] Benzodiazepine dependency requires careful
reduction in dosage to avoid benzodiazepine withdrawal syndrome and other health
consequences.
Dependence on other sedative hypnotics such as zolpidem and zopiclone as well as opiates and
illegal drugs is common in alcoholics.
Alcohol itself is a sedative-hypnotic and is cross-tolerant with other sedative-hypnotics such as
barbiturates, benzodiazepines and nonbenzodiazepines. Dependence upon and withdrawal from
sedative hypnotics can be medically severe and, as with alcohol withdrawal, there is a risk of
psychosis or seizures if not managed properly.[19]
[edit] Epidemiology

Disability-adjusted life year for alcohol use disorders per 100,000 inhabitants in 2002.
no data
less than 50
50–150
150–250
250–350
350–450
450–550
550–650
650–750
750–850
850–950
950–1050
more than 1050

Total recorded yearly alcohol per capita consumption (15+), in litres of pure alcohol[116]
Substance use disorders are a major public health problem facing many countries. "The most
common substance of abuse/dependence in patients presenting for treatment is alcohol."[100] In
the United Kingdom, the number of 'dependent drinkers' was calculated as over 2.8 million in
2001.[117] About 12% of American adults have had an alcohol dependence problem at some time
in their life.[118] The World Health Organization estimates that about 140 million people
throughout the world suffer from alcohol dependence.[22][119] In the United States and western
Europe 10 to 20 percent of men and 5 to 10 percent of women at some point in their lives will
meet criteria for alcoholism.[120]
Within the medical and scientific communities, there is broad consensus regarding alcoholism as
a disease state. For example, the American Medical Association considers alcohol a drug and
states that "drug addiction is a chronic, relapsing brain disease characterized by compulsive drug
seeking and use despite often devastating consequences. It results from a complex interplay of
biological vulnerability, environmental exposure, and developmental factors (e.g., stage of brain
maturity)."[40]
Alcoholism has a higher prevalence among men, though in recent decades, the proportion of
female alcoholics has increased.[21] Current evidence indicates that in both men and women,
alcoholism is 50–60 percent genetically determined, leaving 40–50 percent for environmental
influences.[121] Most alcoholics develop alcoholism during adolescence or young adulthood.[73]
[edit] Prognosis
A 2002 study by the National Institute on Alcohol Abuse and Alcoholism surveyed a group of
4,422 adults meeting the criteria for alcohol dependence and found that after one year, some met
the authors' criteria for low-risk drinking, even though only 25.5 percent of the group received
any treatment, with the breakdown as follows: 25 percent were found to be still dependent, 27.3
percent were in partial remission (some symptoms persist), 11.8 percent asymptomatic drinkers
(consumption increases chances of relapse) and 35.9 percent were fully recovered — made up of
17.7 percent low-risk drinkers plus 18.2 percent abstainers.[122]
In contrast, however, the results of a long term (60 year) follow-up of two groups of alcoholic
men by George Vaillant at Harvard Medical School indicated that "return to controlled drinking
rarely persisted for much more than a decade without relapse or evolution into abstinence."[123]
Vaillant also noted that "return-to-controlled drinking, as reported in short-term studies, is often
a mirage."
The most common cause of death in alcoholics is from cardiovascular complications.[124] There is
a high rate of suicide in chronic alcoholics, which increases the longer a person drinks. This is
believed to be due to alcohol causing physiological distortion of brain chemistry, as well as
social isolation. Suicide is also very common in adolescent alcohol abusers, with 25 percent of
suicides in adolescents being related to alcohol abuse.[125] Approximately 18 percent of alcoholics
commit suicide,[42] and research has found that over 50 percent of all suicides are associated with
alcohol or drug dependence. The figure is higher for adolescents, with alcohol or drug misuse
playing a role in up to 70 percent of suicides.[126]
[edit] History
Alcohol has a long history of use and misuse throughout recorded human history. Biblical,
Egyptian and Babylonian sources record history of abuse and dependence on alcohol. In some
ancient cultures alcohol was worshiped and others its abuse was condemned. Excessive alcohol
misuse and drunkenness were recognised as causing problems thousand of years ago. However,
the defining of habitual drunkenness as it was then known as and its adverse consequences were
not well established medically until the 18th century. In 1647 a Greek monk named Agapios was
the first to document that chronic alcohol misuse was associated with toxicity to the nervous
system and body which resulted in a range of medical disorders such as seizures, paralysis and
internal bleeding. In 1920 the effects of alcohol abuse and chronic drunkenness led to the failed
prohibition of alcohol being considered and eventually enforced briefly in America. In 2005 the
cost of alcohol dependence and abuse was estimated to cost the USA economy approximately
220 billion dollars per year, more than cancer and obesity.[127]
[edit] Society and culture

William Hogarth's Gin Lane, 1751


The various health problems associated with long-term alcohol consumption are generally
perceived as detrimental to society, for example, money due to lost labor-hours, medical costs,
and secondary treatment costs. Alcohol use is a major contributing factor for head injuries, motor
vehicle accidents, violence, and assaults. Beyond money, there are also significant social costs to
both the alcoholic and their family and friends.[61] For instance, alcohol consumption by a
pregnant woman can lead to fetal alcohol syndrome,[128] an incurable and damaging condition.[129]
Estimates of the economic costs of alcohol abuse, collected by the World Health Organization,
vary from one to six percent of a country's GDP.[130] One Australian estimate pegged alcohol's
social costs at 24% of all drug abuse costs; a similar Canadian study concluded alcohol's share
was 41%.[131] One study quantified the cost to the UK of all forms of alcohol misuse in 2001 as
£18.5–20 billion.[117][132]
Stereotypes of alcoholics are often found in fiction and popular culture. The 'town drunk' is a
stock character in Western popular culture. Stereotypes of drunkenness may be based on racism
or xenophobia, as in the depiction of the Irish as heavy drinkers.[133] Studies by social
psychologists Stivers and Greeley attempt to document the perceived prevalence of high alcohol
consumption amongst the Irish in America.

Child abuse is the physical, sexual, emotional mistreatment, or neglect of children.[1] In the
United States, the Centers for Disease Control and Prevention (CDC) define child maltreatment
as any act or series of acts of commission or omission by a parent or other caregiver that results
in harm, potential for harm, or threat of harm to a child.[2] Most child abuse occurs in a child's
home, with a smaller amount occurring in the organizations, schools or communities the child
interacts with. There are four major categories of child abuse: neglect, physical abuse,
psychological/emotional abuse, and child sexual abuse.
Different jurisdictions have developed their own definitions of what constitutes child abuse for
the purposes of removing a child from his/her family and/or prosecuting a criminal charge.
According to the Journal of Child Abuse and Neglect, child abuse is "any recent act or failure to
act on the part of a parent or caretaker which results in death, serious physical or emotional
harm, sexual abuse or exploitation, an act or failure to act which presents an imminent risk of
serious harm".[3]
Domestic violence, also known as domestic abuse, spousal abuse, family
violence and intimate partner violence(IPV), can be broadly defined as a
pattern of abusive behaviors by one or both partners in an intimate relationship
such as marriage, dating, family, friends or cohabitation.[1] Domestic violence has
many forms including physical aggression (hitting, kicking, biting, shoving,
restraining, slapping, throwing objects), or threats thereof; sexual abuse; emotional
abuse; controlling or domineering; intimidation; stalking; passive/covert abuse (e.g.,
neglect); and economic deprivation.[1] Alcohol consumption[2] and mental illness[3]
can be co-morbid with abuse, and present additional challenges when present
alongside patterns of abuse.

Though definitions vary, rape is defined in most jurisdictions as sexual intercourse, or other
forms of sexual penetration, of one person (not necessarily, though almost always "the victim")
by another person (typically "the accused" or "the perpetrator") without the consent of the victim.
The term sexual assault is closely related to rape. Some jurisdictions define "rape" to cover only
acts involving penile penetration of the vagina, treating all other types of non-consensual sexual
activity as sexual assault. The terminology varies, with some places using other terms. For
example, Michigan, United States uses the term "criminal sexual conduct".[8] In some
jurisdictions, rape is defined in terms of sexual penetration of the victim with or without
penetration of objects.[9] Some jurisdictions also consider rape to include the use of sexual organs
of one or both of the parties, such as oral copulation and masturbation. The victim does not have
to be penetrated to be raped; the perpetrator can use objects to stimulate the genitals. The
perpetrator can use their hand to stimulate the genitals. The perpetrator can use drugs (including
alcohol) to incapacitate the victim.
Australian psychologist Sarah Crome argues that male rape victims often get little services and
support in Australia and that male victims report feeling threatened by male staff in court rooms
and the legal system which is based around patriarchal ideology.[10] In Brazil, for example, the
legal code does not legislate against women raping men. Rape is defined as non-consensual
vaginal sex.[11] Therefore, unlike most of Europe and the Americas, male rape, anal rape, and oral
rape are not considered to be rape. Instead, such an act is called a "violent attack against
someone's modesty" ("Atentado violento ao pudor").
Burglary (also called breaking and entering[1] and sometimes housebreaking)[2] is a crime, the
essence of which is entry into a building for the purposes of committing an offense. Usually that
offense will be theft, but most jurisdictions specify others which fall within the ambit of
burglary. To commit a burglary is to burgle (in British English) or burglarize (in American
English).[3]
Assault is a crime of violence against another person. In some jurisdictions, including Australia
and New Zealand, assault refers to an act that causes another to apprehend immediate and
personal violence, while in other jurisdictions, such as much of the United States, assault may
refer only to the threat of violence caused by an immediate show of force.[1][2]
Assault is often defined to include not only violence, but any intentional physical contact with
another person without their consent.[3][4][5] In common law jurisdictions, including England and
Wales and the United States, battery is the crime that represents the unlawful physical contact,
though this distinction does not exist in all jurisdictions. Exceptions exist to cover unsolicited
physical contact which amount to normal social behavior known as de minimis harm. Assault
can also be considered in cases involving the spitting on, or unwanted exposure of bodily fluids
to others.
In most jurisdictions, the intention to cause grievous bodily harm (or its equivalent) may amount
to the mental requirement to prefer a charge of murder in circumstances where the harm inflicted
upon the victim proves fatal.[6][clarification needed]
At common law criminal assault was an attempted battery. The elements of battery are (1) a
volitional act[7] (2) done for the purpose of causing an harmful or offensive contact with another
person or under circumstances that make such contact substantially certain to occur and (3)
which causes such contact.[8] Thus throwing a rock at someone for the purpose of hitting him is a
battery if the rock in fact strikes the person and is an assault if the rock misses. The fact that the
person may have been unaware that the rock had been thrown at him is irrelevant under this
definition of assault. Some jurisdictions have incorporated the definition of civil assault into the
definition of the crime making it a criminal assault to intentionally place another person in "fear"
of a harmful or offensive contact. "Fear" means merely apprehension - awareness rather than any
emotional state.
Termination of employment is the end of an employee's duration with an
employer. Depending on the case, the decision may be made by the employee, the
employer, or mutually agreed upon by both.

Driving under the influence (driving while intoxicated, drunk driving, operating under the
influence, drinking and driving, drink-driving, impaired driving) is the act of operating any
motorized machinery after/during consuming alcohol or other drugs. DUI or DWI are
synonymous terms that represent the criminal offense of operating (or in some jurisdictions
merely being in physical control of) a motor vehicle while being under the influence of alcohol
or drugs or a combination of both.[1] It is a criminal offense in most countries.
All American states have also enacted per se laws that prohibit operating (or in some
jurisdictions merely being in physical control of) a motor vehicle while having a specific blood
alcohol content (BAC) level. One can be prosecuted under the per se laws whether or not they
are actually "impaired" or "under the influence" of alcohol.
In most countries, anyone who is convicted of injuring or killing someone while under the
influence of alcohol or drugs can be heavily fined, as in France, in addition to being given a
lengthy prison sentence. Many states in the U.S. have adopted truth in sentencing laws that
enforce strict guidelines on sentencing. For example, if a defendant is sentenced to ten years, he
or she will be in prison for that entire time. This is different from past practice where prison time
was reduced or suspended after sentencing had been issued.
The specific criminal offense may be called, depending on the jurisdiction, driving under
intense influence (DUII), driving while intoxicated (DWI), operating while intoxicated
(OWI), operating a motor vehicle while intoxicated (OMVI), driving under the influence [of
alcohol or other drugs] (DUI), driving under the combined influence of alcohol and/or other
drugs, driving under the influence per se or drunk in charge [of a vehicle]. Other less
common acronyms include ("OVI"), "operating a vehicle (while) impaired," and ("DWAI"),
"Driving While Ability Impaired."[2] Many such laws apply also to boating, piloting aircraft,
riding a horse or conducting a horse-drawn vehicle, or cycling.
Relational disorders involve two or more individuals and a disordered "juncture," whereas
typical Axis I psychopathology describes a disorder at the individual level. An additional
criterion for a relational disorder is that the disorder cannot be due solely to a problem in one
member of the relationship, but requires pathological interaction from each of the individuals
involved in the relationship.[2]
For example, if a parent is withdrawn from one child but not another, the dysfunction could be
attributed to a relational disorder. In contrast, if a parent is withdrawn from both children, the
dysfunction may be more appropriately attributable to a disorder at the individual level.[3]
Dr. First states that "relational disorders share many elements in common with other disorders:
there are distinctive features for classification; they can cause clinically significant impairment;
there are recognizable clinical courses and patterns of comorbidity; they respond to specific
treatments; and they can be prevented with early interventions. Specific tasks in a proposed
research agenda: develop assessment modules; determine the clinical utility of relational
disorders; determine the role of relational disorders in the etiology and maintenance of individual
disorders; and consider aspects of relational disorders that might be modulated by individual
disorders."[2]
The proposed new diagnosis defines a relational disorder as "persistent and painful patterns of
feelings, behaviors, and perceptions" among two or more people in an important personal
relationship, such a husband and wife, or a parent and children.[4]
According to psychiatrist Darrel Regier, MD, some psychiatrists and other therapists involved in
couples and marital counseling have recommended that the new diagnosis be considered for
possible incorporation into the Diagnostic and Statistical Manual of Mental Disorders (DSM IV).
[4]

Child neglect is defined as "the failure of a person responsible for a child’s care and upbringing
to safeguard the child’s emotional and physical health and general well-being".[1] Like acts of
commission, harm to a child may or may not be the intended consequence.[2]
The following are types of child neglect (not legal definitions):
Failure to provide
• Physical neglect
• Emotional neglect
• Medical/dental neglect
• Educational neglect
Failure to supervise
• Inadequate supervision
• Exposure to violent environments
The term "intimate partner violence" (IPV) is often used synonymously with domestic
abuse/domestic violence. Family violence is a broader definition, often used to include child
abuse, elder abuse, and other violent acts between family members.[5] Wife abuse, wife beating,
and battering are descriptive terms that have lost popularity recently for at least two reasons:
• Acknowledgment that many victims are not actually married to the abuser, but rather
cohabiting or other arrangement.[6]
• Abuse can take other forms than physical abuse and males are often victims of violence
as well. Other forms of abuse may be constantly occurring, while physical abuse happens
occasionally.
These other forms of abuse have the potential to lead to mental illness, self-harm, and even
attempts at suicide.[7][8]
Amartya Sen calculated that between 60 million and 107 million women are missing worldwide.
[9]

The U. S. Office on Violence Against Women (OVW) defines domestic violence as a "pattern of
abusive behavior in any relationship that is used by one partner to gain or maintain power and
control over another intimate partner". The definition adds that domestic violence "can happen to
anyone regardless of race, age, sexual orientation, religion, or gender", and that it can take many
forms, including physical abuse, sexual abuse, emotional, economic, and psychological abuse.[10]
The Children and Family Court Advisory and Support Service in the United Kingdom in its
"Domestic Violence Policy" uses domestic violence to refer to a range of violent and abusive
behaviours, defining it as:
Patterns of behaviour characterised by the misuse of power and control by one person over
another who are or have been in an intimate relationship. It can occur in mixed gender
relationships and same gender relationships and has profound consequences for the lives of
children, individuals, families and communities. It may be physical, sexual, emotional and/or
psychological. The latter may include intimidation, harassment, damage to property, threats and
financial abuse.[11]
In Spain, the 2004 Measures of Integral Protection Measures against Gender Violence defined
gender violence as a violence that is directed at women for the very fact of being women. The
law acknowledges that aggressions against women have a particular incidence in the reality of
Spain and that gender violence stands as the most brutal symbol of the inequality persisting in
Spain. According to the law, women are considered by their attackers as lacking the basic rights
of freedom, respect, and power of decision.[12]

What causes alcoholism?


The cause of alcoholism is not well established. There is growing evidence for genetic and
biologic predispositions for this disease, but this research is controversial. Studies examining
adopted children have shown that children of alcoholic biological parents have an increased risk
of becoming alcoholics. Relatively recent research has implicated a gene (D2 dopamine
receptor gene) that, when inherited in a specific form, might increase a person's chance of
developing

alcoholism. Twice as many men are alcoholics. And 10-23% of alcohol-consuming individuals
are considered alcoholics.
Usually, a variety of factors contribute to the development of a problem with alcohol. Social
factors such as the influence of family, peers, and society, and the availability of alcohol, and
psychological factors such as elevated levels of stress, inadequate coping mechanisms, and
reinforcement of alcohol use from other drinkers can contribute to alcoholism. Also, the factors
contributing to initial alcohol use may vary from those maintaining it, once the disease develops.
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 the 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
addiction. If you have an imbalance of brain chemicals, you may be more predisposed to
alcoholism.
 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 suffering from 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 lead to 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 entertainment media sends many people messages that it's OK to drink
excessively.

Causes of Alcoholism
Causes of Alcoholism
Why can one person drink and never have to worry about developing the disease called
alcoholism, while another person is in jeopardy by merely taking one sip, what causes
alcoholism in one person and not another?
Like the onset of many other diseases, alcoholism may afflict one person and not another
because of individual factors or circumstances.
Alcohol is brain altering
Other causes of alcoholism are alcohol alters the balance of some brain chemicals. For example,
gamma-aninobutyric acid (GABA) controls impulsive actions, but under the influence of
alcohol, that function is decreased. Another chemical is glutamate which stimulates the central
nervous system. Alcohol alters the levels of dopamine, which contributes to the pleasurable
“click” that people with the disease experience when taking the first drink. When the brain
chemistry is changed, the body begins to crave alcohol, thus more and more drug is needed to
“feel good.” This is another of the causes of alcoholism.
Trying to feel good
People naturally want to feel good, and when something makes you feel good, such as taking a
drink, it’s understandable you will want to repeat the experience. That “click” is the first warning
sign of potential problems. The disease progresses as alcohol changes brain chemistry. When
brain chemicals are increased or decreased, the body craves more and more alcohol. The body
“needs” the alcohol to feel good. Alcoholism has set in.
1

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What risk factors are causes of alcoholism


There are several possible causes of alcoholism and risk factors for the disease. The individual is
the determining factor when assessing risk of contracting the disease. One or more of these
causes/risk factors can indicate the presence of alcohol abuse or addiction.
Genetic: If your parents or grandparents were addicted to alcohol, the chances are strong that
you will be vulnerable to the disease. Healthcare professionals will take a family history to look
for risk factors for many diseases. Alcoholism is no different. Children of alcoholics will not
necessarily become alcoholics themselves, but the medical history indicates a possibility.
Emotional Makeup: People may use alcohol to block the pain in the life. Alcohol is used as a
coping device and there are certain stress hormones that may contribute to the progression of the
disease.
Psychological: People suffering from depression or low self esteem may be more likely to
develop a drinking problem. They are more likely to try to “fit in” with their friends, who
“enable” the problem to continue.
Social: Alcohol is legal, readily available and drinking is socially acceptable. Alcohol is
promoted heavily in the media, and having a few beers before, during and after a sporting event
is part of American culture. There is a peer pressure to drink, to be a part of the crowd.
Frequency: Drinking alcohol regularly can cause alcoholism. People who drink regularly over
time may be at risk of developing a physical dependence on alcohol. If studies show that one/two
drinks per day for the average person (15 per week for men, 12 per week for women) is within
safe limits, then it follows that going beyond that limit can produce problems.
Age: Young people are at greater risk of developing alcoholism, especially if they start drinking
by age 16 or sooner.
Gender: Men are more likely to develop the disease than women.
If a person has risk factors at play, that does not mean they are automatically going to develop
the disease; it is not necessarily a causes of alcoholism. It is possible, likewise, for a person with
no risk factors at all, no family history, to develop the disease. It is important for people to know
the risk factors and the causes of the disease to avoid getting into trouble with alcohol.
It can’t happen to me!
Another common mistake people make is assuming “it won’t happen to me.” In a society that
glorifies alcohol consumption, from beers at sporting events, to fine wines at upscale
establishments, the risk factors are obvious. Two martini lunches and bourbon on the rocks after
office hours are indicators that
Americans embrace alcohol use. Alcohol is everywhere. Education is important, to understand
how the disease progresses, how it can be managed or avoided, and how it impacts our society in
general.
Not everybody who drinks develops the disease, but it is important to understand that it is
possible and that moderation is a key element in maintaining a healthy balance. If there are risk
factors present, if a person begins to use alcohol more frequently, or daily, then there may be a
problem. (See signs and symptoms.) LINK
Everywhere in our culture
Because alcohol is so prevalent in our society, because it is so widely accepted if not embraced,
it is difficult to see when a person is slipping from social drinking into something more
problematic. The individual who is on the downward slide is not likely to recognize any of the
signs and therefore needs others to intercede.
We encourage you to examine these risk factors and causes of alcoholism to see if there is a
problem in your life, or with someone you love, or someone you know. If there is, please seek
the help of an alcohol treatment professional.
Causes of Alcoholism
With recognition to Peet Duvenage

In many cases alcoholism has deeper lying causes that do not disappear once the
drinker is sober.
Personality/traits
Education/development
Established behaviour patterns
Environment
Religion
Damaged relationships

Personality/traits. The following attributes are considered to be generally applicable to


people that become alcoholics (Catanzaro, Ronald J: ALCOHOLISM, Charles C.
Thomas, 1968, pp16-19).
Emotional immaturity.
Overly dependent on their parents.
Inability to communicate and be engaged on his deeper experiences.
Tension in his relationships with others.
Inability to manage frustration.
Keeping a front (as a defence mechanism to hide his sense of guilt, poor self image
and other problems).
Perfectionism.
Competitiveness.
A sense of feeling inferior as a man or woman.
A feeling of guilt.

Education/development. A study by the McCords (ORIGINS OF ALCOHOLISM,


Travistock Publications, 1959) has indicated the following negative circumstances as
having an above average occurrence in the case of alcoholics.
Conflict between parents.
Poor religious experiences.
Nervous parents.
Sexual deviations by the parents.
Contradictory behaviour of especially the mother.
Sidestepping instead of addressing problems.
A father despising the mother.
A mother that is unhappy with her role as mother.
Lack of discipline.
Low expectations of the child.
Lack of leadership.
Established behaviour patterns. Addiction tends to develop over time. With and without
addiction humans establish set behaviour patterns. These patterns do not change
simply because the addiction has been broken.
Environment. Alcohol is a method to escape from
emotional pain
crises
boredom
distress
fatigue

Religion
All humans have a need for security. Religious people experience it via their religion.
Alcohol is sometimes called God-in-the-bottle. Alcohol can have the same value to the
alcoholic as religion may have for a religious person. For alcoholics alcohol removes the
feeling of guilt and inferiority and replaces it with a false sense of security. Insecurity
returns when becoming sober again.
Social need. Humans want to live with and experience other humans. In a healthy
religious community a sense of communion is experienced. Alcoholics tend to have
very low social skills and therefore do not experience this sense of communion. This is
falsely created by having drinking partners or liking the atmosphere in a bar. Alcohol
becomes their social lubricant.
However, genetics also play a role and there are indications that alcoholism can be
inherited.
Alcoholism and Its Effect on the Family
Tetyana Parsons
December 14, 2003

According to the Random House Dictionary of the English Language (1966), alcoholism is defined as “ a
diseased condition due to the excessive use of alcoholic beverages” (p.35) Silverstein in his book
“Alcoholism” (1990) gives three criteria that the American Psychiatric Association listed for physicians to
diagnose this disease (p.30) :

1. physiological problems, such as hand tremors and blackouts


2. psychological problems, such as an obsessive desire to drink
3. behavioral problems that disrupt social or work life

Alcoholics can be of any age, background, income level, social, or ethnic group. Very often alcoholism
affects highly educated people. Several studies even showed that people who lack motivation are less
likely to become addicted to alcohol than highly motivated individuals (Silverstein, 1990).

Alcoholism is also known as a family disease. Alcoholics may have young, teenage, or grown-up children;
they have wives or husbands; they have brothers or sisters; they have parents or other relatives. An
alcoholic can totally disrupt family life and cause harmful effects that can last a lifetime. According to U. S.
Department of Health and Human Services and SAMHSA’s (Substance Abuse & Mental Health Services
Administration) National Clearinghouse for Alcohol and Drug Information, seventy six million American
adults have been exposed to alcoholism in the family. Alcoholism is responsible for more family problems
than any other single cause. According to Silverstein (1990), one of every four families has problems with
alcohol.

Each member of the family may be affected by alcohol differently. Parental alcoholism may affect the
fetus even before a child is born. In pregnant women, alcohol is carried to all of the mother’s organs and
tissues, including the placenta, where it easily crosses through the membrane separating the maternal
and fetal blood systems. When a pregnant woman drinks an alcoholic beverage, the concentration of
alcohol in her unborn baby’s bloodstream is the same level as her own. A pregnant woman who
consumes alcohol during her pregnancy may give birth to a baby with Fetal Alcohol Syndrome (FAS).
Fetal Alcohol Syndrome is one of the three top known causes of birth defects. According to the National
Council on Alcoholism and Drug Dependence, about 5000 babies are born each year with severe
damage caused by FAS; another 35000 babies are born with more mild forms of FAS (Berger, p.37).

In general, the more severe the mother’s drinking problem during pregnancy, the more severe the
symptoms of FAS in infants. Babies born with FAS are shorter and underweight compared to normal
babies. They have deformities of the brain and skull, and very characteristic facial features such as small
eye openings; thin upper lips; long, flat faces; and a long groove in the middle of their upper lips. These
children’s central nervous systems are also damaged. As a result, children with Fetal Alcohol Syndrome
have difficulties in learning, attention span, judgment, memory, problem-solving, and frequently behavior
problems. Children with FAS may also have problems with social skills. Their frustration easily turns to
anger as they grow older. These children are hyperactive – unable to sit or stand still for a long time. They
are often impulsive, poorly coordinated, and have impaired speech and hearing. Fetal Alcohol Syndrome
and its effects are permanent, often leading to lifelong problems with mental retardation.

Parental alcoholism also has severe effects on normal children of alcoholics. Many of these children have
common symptoms such as low self-esteem, loneliness, guilt, feelings of helplessness, fears of
abandonment, and chronic depression (Berger, 1993). Children of alcoholics (COAs) may feel
responsible for the problems of the alcoholic and may think they created the problem. COAs often
experience high levels of tension and stress. Young children of alcoholics may have frequent nightmares,
bed wetting, and crying. They also may not have friends and may be afraid to go to school. Older children
of alcoholics may show such depressive symptoms as obsessive perfectionism, hoarding, staying by
themselves, or being excessively self-conscious. Studies have shown that because children of alcoholics
feel that they are different from other people, they develop a poor self-image, in which they closely
resemble their alcoholic parents (Silverstein, 1990, p.75). Also, teenage children of alcoholics may
develop phobias.

COAs more often have problems in school. The stressful environment at home prevents them from
studying. Their school performance may also be affected by inability to express themselves. Often COAs
have difficulty in establishing relationships with teachers and classmates. COAs tend more often to have
to repeat the academic year and more often drop out of school. A Unites States government survey,
“Exposure to Alcoholism in the Family”, shows that 30 percent of young women who didn’t complete high
school had grown up in families with alcoholic parents (Berger, 1993, p.75). The same survey shows that
only 20 percent of young men from alcoholic families went to college. Some COAs have such behavioral
problems as lying, stealing, fighting, and truancy. These children live in extremely unstable home
environments. They never know what to expect from an alcoholic parent. Because they are unable to
predict their parent’s mood, they don’t know how to behave themselves. Just like non-alcoholic spouses,
COAs think they can stop their alcoholic parent from drinking by hiding liquor, or by pleasing the parent
with good grades in school. They may tiptoe around the house while the alcoholic parent sleeps, hoping
not to awake the drunken person until enough time has passed for the alcoholic parent to “sober up”.
Children of alcoholics feel guilty for their failure to save their parents from the effects of alcohol.

Because crime and violence are associated with alcoholism, incest and battering are common in
alcoholics’ families. According to Berger, almost 30 percent of father – daughter incest cases and 75
percent of domestic violence cases involve a family member who is an alcoholic. Incest and battering
victims often blame themselves for what has happened. Because they feel so guilty, ashamed, and
helpless, they themselves may turn to drinking as the way to escape the pain. “Children of alcoholics are
people who have been robbed of their childhood” (Silverstein, 1990, p.75). Children of alcoholics, if
untreated as children, carry their problems into later life.

Adult children of alcoholics (ACOAs) often don’t relate their problems to having grown up in a family with
an alcoholic parent. Many of them have problems of depression, aggression, or impulsive behavior. Some
studies have shown that ACOAs have problems with abuse of different psychoactive substances, and
difficulty in establishing healthy relationships with others. They are frequently failures as parents
themselves, often make poor career choices, and almost all ACOAs have a negative self-image (Berger,
1993, p.67). Adult children of alcoholics often have feelings of worthlessness and failure. They also may
have problems with family responsibility because their alcoholic parent was irresponsible and didn’t
provide them with basic children’s needs.

Many ACOAs have problems with intimacy, because their previous experience has taught them not to
trust other people. They may also think that if they will love someone, this person will hurt them in the
future, just the same as their alcoholic parent did. Unfortunately, research has shown that many ACOAs
often find themselves intimately involved with someone who is an alcoholic, or in some way abusive
(Wekesser, 1994, p.143). ACOAs are four times more likely than children of non-alcoholics to develop
alcoholism. Genetic factors play a major role in the development of alcoholism. Another factor is inability
to deal with stress in a healthy way. Joseph A. Califano, former United States Secretary of Health and
Human Services, pointed out some other facts about ACOAs. He says, “sons of alcoholics see doctors
more often than those raised in non-alcoholic homes. Further, they have higher rates of such
psychological or mental disorders as anxiety, depression, and introversion” (Berger, p.69). Berger also
states that adult daughters of alcoholics tend to have more reproductive problems and see their
gynecologists and obstetricians more often. In addition, they have higher rates of an eating disorder –
bulimia.

Alcoholism also has negative effects on the spouse of an alcoholic. The spouse may have feelings of
hatred, self-pity, avoidance of social contacts, may suffer exhaustion and become physically or mentally ill
(Berger, 1993).Very often the spouse has to perform the roles of both parents. Family responsibilities shift
from two parents to one parent. As a result, the non-alcoholic parent may be inconsistent, demanding,
and often neglect the children. Having financial difficulties is another issue that families of alcoholics have
to deal with. The family may have to give up certain privileges because of the large amount of money
spent on alcohol and also possible joblessness. A survey, “Exposure to Alcoholism in the Family”,
conducted in 1988 suggested that alcoholism is a major factor of premature widowhood (Berger, 1993,
p.13). Alcoholism also is one of the major reasons for divorce.

Today, experts who study alcoholic families know that family and marital problems often start because of
alcoholism, but they also learned that spouses and children may contribute to the drinker’s habit and
make it worse. Some of the families allow heavy drinking to continue rather than deal with serious family
problems, and keep the habit going in exchange for keeping the family together. Denial is an essential
problem for alcoholics and family members. Family members use denial to rationalize the drinker’s
alcohol dependency. In the beginning, denial is understandable because every family loves and wants to
protect its members, but there comes a time when denial negatively affects family members. When family
members deny the obvious and refuse to look for help, their behavior can trigger multiple emotional
problems in the children of the family.

Members of alcoholic’s families very often become codependent. “Codependency is an unconscious


addiction to another person’s abnormal behavior” (Wekesser, 1994, p.168). Most alcoholics have periods
when they stop drinking for a short while and seemingly do well, leading the codependent person to
believe that the problem can be solved. Often people who don’t know the alcoholic very well don’t suspect
any problem. The alcoholic’s codependent family members do everything possible to hide the problem,
preserve the family’s prestige and project the image of a “perfect family”. The spouse and children may
avoid making friends and bringing other people home, in order to hide problems caused by alcoholism.
Codependent members often forget about their own needs and desires. They devote their lives to attempt
to control or cure the drinker. Unknowingly, codependent family members often become “enablers”. An
enabler is “a person who unknowingly helps the alcoholic by denying the drinking problem exists and
helping the alcoholic to get out of troubles caused by his drinking” (Silverstein, 1990, p.65). The enabler
will clean up the alcoholic’s vomit and make excuses to his or her boss, teacher, or friends. The enabler
lies for the alcoholic, and thus enables the alcoholic to continue drinking.

While alcoholism treatment programs such as Alcoholics Anonymous help people with alcohol
dependence to stop drinking and improve their life styles, family and marital therapy and various self-help
groups help alcoholic families to improve their own well-being. Families of alcoholics need treatment just
as much as alcoholics. Marriage and family counselors can help with the tensions created in the
alcoholic’s home. School counselors can provide information and support to adolescents who have family
problems because of parental alcoholism. Therapists in hospitals and mental health centers, and state-
run alcohol programs provide information and services for alcohol related problems. According to
Silverstein (1990), Al-Anon and Alateen are two of the most successful organizations helping families of
alcoholics. Al-Anon is designed to mainly help the spouses of alcoholics, while Alateen is designed to
help children of the alcoholic. Both organizations’ philosophy is based upon Alcoholic Anonymous’s
Twelve Step Recovery Program. The main goal of these organizations is to help family members
understand that they are not responsible for an alcoholic’s drinking problems and that family members’
recovery does not depend upon the alcoholic’s recovery.

Alcohol affects each member of the family – from the unborn child to the alcoholic’s spouse. Its far-
reaching affects result in not only physical problems for the alcoholics, but also may result in physical and
psychological problems for other members of the family. Treatment is complicated and often is not
completely successful. Even if the alcoholic himself ultimately reforms, the family members who were so
greatly affected may not themselves ever recover from the problems inflicted upon them.
References

Effects of Alcoholism on Families

The effects of alcoholism


on families can cause more
damage and pain than any other internal or external influence on the family unit. The impact of
the drinker’s abuse or addiction is usually manifested differently with each member of the family
and has long-term implications.
The National Institute on Alcohol Abuse and Alcoholism reports that more than one-half of
adults in the U.S. have a close family member who has abused alcohol or is addicted to the drug.

Children of Parents who Drink


Unborn Babies: Women who drink during pregnancy pass the drug to their unborn children each
time they consume alcohol. Maternal drinking causes babies to be born with irreversible physical
and mental birth defects.
This condition is called Fetal Alcohol Syndrome (FAS) and these children grow up with facial
abnormalities, growth retardation and brain damage that inhibits their ability to live normal lives.
According to the National Council on Alcoholism and Drug Dependence, severe damage from
FAS affects around 5000 babies every year; additionally 35000 babies are born with milder
damage from FAS.
Children: Children who are born without birth defects and live with a father and/or mother who
is an alcohol abuser or addict experience severe effects that may include:
• Low self-esteem
• Feelings of guilt and despair
• Loneliness and fear of abandonment
• Chronic depression
• High levels of anxiety and stress
They may believe that their parent’s drinking is their fault and frequently cry, have nightmares
and wet their beds. Once they get older, children may not easily make friends. They may hoard
things, develop phobias or exhibit perfectionist traits.
Through the effects of alcoholism on families, children often feel they are different that other
people and develop a poor self-image that they carry throughout life.
They have difficulties in school and establishing relationships with friends and teachers. And
fewer children of alcoholics go to college compared to the national average.
In addition, living in an alcoholic family also suggests that children are more susceptible to child
abuse, including incest and battery.
Adult Children of Alcoholics: Once children become adults, the effects of alcoholism on families
continue to impact their lives. They experience difficulties trusting others and have relationship
issues.
Depression is common, as is anxiety, aggression and impulsive behavior. Adult children of
alcoholics continue having a negative self-image, which causes them to make poor choices and
accumulate failures in their work, social and family lives.
Spouse or Partner
Alcoholism has a transforming effect on the spouse or partner that can create significant mental
trauma and physical health problems. Divorce rates among couples where one or both partners
drinks is much higher than average.
As alcohol abuse or addiction progresses, the non-drinking spouse often grows into a compulsive
care-taking role, which creates feelings of resentment, self-pity and exhaustion. The marriage
suffers from:
• Poor spousal communication
• Increased anger and distress
• Reduced intimacy and sexual desire
• Increased marital abuse
• Depleting finances spent on alcohol
Often the spouse and children become codependent, as one of the effects of alcoholism in
families. Codependents, who are also referred to as enablers, further the alcoholic’s drinking
problem by trying to protect them and keep them out of trouble.
This may include telling an employer a lie about why the individual didn’t come to work, telling
friends stories to explain the alcoholic’s behavior, or handling a responsibility that should have
been taken care of by the drinker.
Codependents make the problem worse by permitting the drinking to continue. Effects of
Alcoholism on Families … Is there Help?
Treating alcoholic families is difficult and complex. Often treatment is not entirely successful for
family members, even when the alcohol abuser or addict eventually reforms.
The effects of alcoholism in families are difficult to overcome; yet without treatment, they can be
devastating for the long-term. With the right approach and support, positive steps can be taken to
improve lives.
Healthcare professionals may recommend a multi-faceted treatment approach that includes group
family therapy, as well as individualized treatment for each family member Treatment may take
the form of one or more of the following:
• Interventions
• Out-Patient Programs
• In-Patient Programs
• Peer Support Groups
• Psycho-Social Therapy
• Medication-Assisted Treatment

Alcoholism and Alcohol Abuse


Signs, Symptoms, and Help for Drinking Problems
Drinking is woven into the fabric of many societies—sharing a bottle of wine over a meal, going
out for drinks with friends, celebrating special occasions with champagne. But because alcohol is
such a common, popular element in many activities, it can be hard to see when your drinking has
crossed the line from moderate or social use to problem drinking.
If you consume alcohol simply to feel good, or to avoid feeling bad, your drinking could become
problematic. Alcoholism and alcohol abuse can sneak up on you, so it’s important to be aware of
the warning signs and take steps to cut back if you recognize them. Understanding the problem is
the first step to overcoming it.
In This Article:
• Understanding drinking problems
• Signs & symptoms of alcohol abuse
• Signs & symptoms of alcoholism
• Drinking problems and denial
• Effects of alcoholism
• Getting help for alcohol abuse
• When a loved one has a drinking problem
• Related links

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Understanding drinking problems
Drinking problems are due to many interconnected factors, including genetics, how you were
raised, your social environment, and your emotional health. Some racial groups, such as
American Indians and Native Alaskans, are more at risk than others of developing alcohol
addiction. People who have a family history of alcoholism or who associate closely with heavy
drinkers are more likely to develop drinking problems. Finally, those who suffer from a mental
health problem such as anxiety, depression, or bipolar disorder are also particularly at risk,
because alcohol may be used to self-medicate.
Since drinking is so common in many cultures and the effects vary so widely from person to
person, it’s not always easy to figure out where the line is between social drinking and problem
drinking. The bottom line is how alcohol affects you. If your drinking is causing problems in
your life, you have a drinking problem.
Do you have a drinking problem?
You may have a drinking problem if you...
• Feel guilty or ashamed about your drinking.
• Lie to others or hide your drinking habits.
• Have friends or family members who are worried about your drinking.
• Need to drink in order to relax or feel better.
• “Black out” or forget what you did while you were drinking.
• Regularly drink more than you intended to.
Signs and symptoms of alcohol abuse
Substance abuse experts make a distinction between alcohol abuse and alcoholism (also called
alcohol dependence). Unlike alcoholics, alcohol abusers have some ability to set limits on their
drinking. However, their alcohol use is still self-destructive and dangerous to themselves or
others.
Common signs and symptoms of alcohol abuse include:
• Repeatedly neglecting your responsibilities at home, work, or school because of your
drinking. For example, performing poorly at work, flunking classes, neglecting your
kids, or skipping out on commitments because you’re hung over.
• Using alcohol in situations where it’s physically dangerous, such as drinking and
driving, operating machinery while intoxicated, or mixing alcohol with prescription
medication against doctor’s orders.
• Experiencing repeated legal problems on account of your drinking. For example,
getting arrested for driving under the influence or for drunk and disorderly conduct.
• Continuing to drink even though your alcohol use is causing problems in your
relationships. Getting drunk with your buddies, for example, even though you know
your wife will be very upset, or fighting with your family because they dislike how you
act when you drink.
• Drinking as a way to relax or de-stress. Many drinking problems start when people use
alcohol to self-soothe and relieve stress. Getting drunk after every stressful day, for
example, or reaching for a bottle every time you have an argument with your spouse or
boss.
The path from alcohol abuse to alcoholism
Not all alcohol abusers become full-blown alcoholics, but it is a big risk factor. Sometimes
alcoholism develops suddenly in response to a stressful change, such as a breakup, retirement, or
another loss. Other times, it gradually creeps up on you as your tolerance to alcohol increases. If
you’re a binge drinker or you drink every day, the risks of developing alcoholism are even
greater.
Signs and symptoms of alcoholism (alcohol dependence)
Alcoholism is the most severe form of problem drinking. Alcoholism involves all the symptoms
of alcohol abuse, but it also involves another element: physical dependence on alcohol. If you
rely on alcohol to function or feel physically compelled to drink, you’re an alcoholic.
Tolerance: The 1st major warning sign of alcoholism
Do you have to drink a lot more than you used to in order to get buzzed or to feel relaxed? Can
you drink more than other people without getting drunk? These are signs of tolerance, which can
be an early warning sign of alcoholism. Tolerance means that, over time, you need more and
more alcohol to feel the same effects.
Withdrawal: The 2nd major warning sign of alcoholism
Do you need a drink to steady the shakes in the morning? Drinking to relieve or avoid
withdrawal symptoms is a sign of alcoholism and a huge red flag. When you drink heavily, your
body gets used to the alcohol and experiences withdrawal symptoms if it’s taken away. These
include:

• Anxiety or jumpiness
• Shakiness or trembling
• Sweating
• Nausea and vomiting
• Insomnia
• Depression
• Irritability
• Fatigue
• Loss of appetite
• Headache

In severe cases, withdrawal from alcohol can also involve hallucinations, confusion, seizures,
fever, and agitation. These symptoms can be dangerous, so talk to your doctor if you are a heavy
drinker and want to quit.
Other signs and symptoms of alcoholism (alcohol dependence)
• You’ve lost control over your drinking. You often drink more alcohol than you wanted
to, for longer than you intended, or despite telling yourself you wouldn’t.
• You want to quit drinking, but you can’t. You have a persistent desire to cut down or
stop your alcohol use, but your efforts to quit have been unsuccessful.
• You have given up other activities because of alcohol. You’re spending less time on
activities that used to be important to you (hanging out with family and friends, going to
the gym, pursuing your hobbies) because of your alcohol use.
• Alcohol takes up a great deal of your energy and focus. You spend a lot of time
drinking, thinking about it, or recovering from its effects. You have few if any interests or
social involvements that don’t revolve around drinking.
• You drink even though you know it’s causing problems. For example, you recognize
that your alcohol use is damaging your marriage, making your depression worse, or
causing health problems, but you continue to drink anyway.
Drinking problems and denial
Denial is one of the biggest obstacles to getting help for alcohol abuse and alcoholism. The
desire to drink is so strong that the mind finds many ways to rationalize drinking, even when the
consequences are obvious. By keeping you from looking honestly at your behavior and its
negative effects, denial also exacerbates alcohol-related problems with work, finances, and
relationships.
If you have a drinking problem, you may deny it by:
• Drastically underestimating how much you drink
• Downplaying the negative consequences of your drinking
• Complaining that family and friends are exaggerating the problem
• Blaming your drinking or drinking-related problems on others
For example, you may blame an ‘unfair boss’ for trouble at work or a ‘nagging wife’ for your
marital issues, rather than look at how your drinking is contributing to the problem. While work,
relationship, and financial stresses happen to everyone, an overall pattern of deterioration and
blaming others may be a sign of trouble.
If you find yourself rationalizing your drinking habits, lying about them, or refusing to discuss
the subject, take a moment to consider why you’re so defensive. If you truly believe you don’t
have a problem, why do you feel the need to cover up your drinking or make excuses? Is it
possible that your drinking means more to you than you’re ready to admit?
Five myths about alcoholism
Myth #1: I can stop drinking anytime I want to.
Maybe you can; more likely, you can’t. Either way, it’s just an excuse to keep drinking. The
truth is, you don’t want to stop. Telling yourself you can quit makes you feel in control, despite
all evidence to the contrary and no matter the damage it’s doing.
Myth #2: My drinking is my problem. I’m the one it hurts, so no one has the right to tell me
to stop.
It’s true that the decision to quit drinking is up to you. But you are deceiving yourself if you
think that your drinking hurts no one else but you. Alcoholism affects everyone around you—
especially the people closest to you. Your problem is their problem.
Myth #3: I don’t drink every day, so I can’t be an alcoholic OR I only drink wine or beer,
so I can’t be an alcoholic.
Alcoholism is NOT defined by what you drink, when you drink it, or even how much you drink.
It’s the EFFECTS of your drinking that define a problem. If your drinking is causing problems in
your home or work life, you have a drinking problem and may be an alcoholic—whether you
drink daily or only on the weekends, down shots of tequila or stick to wine, drink three bottles of
beers a day or three bottles of whiskey.
Myth #4: I’m not an alcoholic because I have a job and I’m doing okay.
You don’t have to be homeless and drinking out of a brown paper bag to be an alcoholic. Many
alcoholics are able to hold down jobs, get through school, and provide for their families. Some
are even able to excel. But just because you’re a high-functioning alcoholic doesn’t mean you’re
not putting yourself or others in danger. Over time, the effects will catch up with you.
Myth #5: Drinking is not a “real” addiction like drug abuse.
Alcohol is a drug, and alcoholism is every bit as damaging as drug addiction. Alcohol addiction
causes changes in the body and brain, and long-term alcohol abuse can have devastating effects
on your health, your career, and your relationships. Alcoholics go through physical withdrawal
when they stop drinking, just like drug users do when they quit.
Effects of alcoholism and alcohol abuse
Alcoholism and alcohol abuse can affect all aspects of your life. Long-term alcohol use can
cause serious health complications, affecting virtually every organ in your body, including your
brain. Problem drinking can also damage your emotional stability, finances, career, and your
ability to build and sustain satisfying relationships. Alcoholism and alcohol abuse can also have
an impact on your family, friends andthe people you work with.
The effects of alcoholism and alcohol abuse on the people you love

Despite the potentially lethal damage that heavy drinking does to the
body—including cancer, heart problems, and liver disease—the social consequences can be just
as devastating. Alcoholics and alcohol abusers are much more likely to get divorced, have
problems with domestic violence, struggle with unemployment, and live in poverty.
But even if you’re able to succeed at work or hold your marriage together, you can’t escape the
effects that alcoholism and alcohol abuse has on your personal relationships. Drinking problems
put an enormous strain on the people closest to you.
Often, family members and close friends feel obligated to cover for the person with the drinking
problem. So they take on the burden of cleaning up your messes, lying for you, or working more
to make ends meet. Pretending that nothing is wrong and hiding away all of their fears and
resentments can take an enormous toll. Children are especially sensitive and can suffer long-
lasting emotional trauma when a parent or caretaker is an alcoholic or heavy drinker.
Getting help for alcoholism or alcohol abuse
If you’re ready to admit you have a drinking problem, you’ve already taken the first step. It takes
tremendous strength and courage to face alcohol abuse and alcoholism head on. Reaching out for
support is the second step.
Whether you choose to go to rehab, rely on self-help programs, get therapy, or take a self-
directed treatment approach, support is essential. Recovering from alcohol addiction is much
easier when you have people you can lean on for encouragement, comfort, and guidance.
Without support, it’s easy to fall back into old patterns when things get tough.
Getting sober is only the beginning
Your continued recovery depends on continuing mental health treatment, learning healthier
coping strategies, and making better decisions when dealing with life’s challenges. In order to
stay alcohol-free for the long term, you’ll also have to face the underlying problems that led to
your alcoholism or alcohol abuse in the first place. Those problems could be depression, an
inability to manage stress, an unresolved trauma from your childhood, or any number of mental
health issues. Such problems may become more prominent when you’re no longer using alcohol
to cover them up. But you will be in a healthier position to finally address them and seek the help
you need.

Starting down the road to recovery


Alcoholism is a complex disorder that can affect every aspect of your life. Overcoming it
requires making changes to the way you live, deal with problems, and relate to others. Reducing
or stopping drinking takes commitment and support. The good news is that there are many tools
that can help you on your journey to sobriety.
Read: Alcohol Help and Treatment: How to Stop Drinking and Start Recovery
When a loved one has a drinking problem
If someone you love has a drinking problem, you may be struggling with a number of painful
emotions, including shame, fear, anger, and self-blame. The problem may be so overwhelming
that it seems easier to ignore it and pretend that nothing is wrong. But in the long run denying it
will be more damaging to you, other family members, and the person with the drinking problem.
What Not To Do
• Don't attempt to punish, threaten, bribe, or preach.
• Don't try to be a martyr. Avoid emotional appeals that may only increase feelings of guilt
and the compulsion to drink or use other drugs.
• Don't cover up or make excuses for the alcoholic or problem drinker or shield them from
the realistic consequences of their behavior.
• Don't take over their responsibilities, leaving them with no sense of importance or
dignity.
• Don't hide or dump bottles, throw out drugs, or shelter them from situations where
alcohol is present.
• Don't argue with the person when they are impaired.
• Don't try to drink along with the problem drinker.
• Above all, don't feel guilty or responsible for another's behavior.
Adapted from: National Clearinghouse for Alcohol & Drug Information
Dealing with a loved one’s alcohol problem can be an emotional rollercoaster. It’s vital that you
take care of yourself and get the support you need. It’s also important to have people you can
talk honestly and openly with about what you’re going through.
A good place to start is by joining a group such as Al-Anon, a free peer support group for
families coping with alcoholism. Listening to others with the same challenges can be a
tremendous source of comfort and support. You can also turn to trusted friends, a therapist, or
people in your faith community.
• You cannot force someone you love to stop abusing alcohol. As much as you may
want to, and as hard as it is to watch, you cannot make someone stop drinking. The
choice is up to them.
• Don’t expect the person to stop drinking and stay sober without help. Your loved one
will need treatment, support, and new coping skills to overcome a serious drinking
problem.
• Recovery is an ongoing process. Recovery is a bumpy road, requiring time and patience.
An alcoholic will not magically become a different person once sober. And the problems
that led to the alcohol abuse in the first place will have to be faced.
Admitting that there’s a serious problem can be painful for the whole family, not just the alcohol
abuser. But don’t be ashamed. You’re not alone. Alcoholism and alcohol abuse affects millions
of families, from every social class, race, and culture. But there is help and support available for
both you and your loved one.
When your teen has a drinking problem
Discovering your child is drinking can generate fear, confusion, and anger in parents. It’s
important to remain calm when confronting your teen, and only do so when everyone is sober.
Explain your concerns and make it clear that your concern comes from a place of love. It’s
important that your teen feels you are supportive.
Five steps parents can take:
1. Lay down rules and consequences: Your teen should understand that drinking alcohol
comes with specific consequences. But don’t make hollow threats or set rules that you
cannot enforce. Make sure your spouse agrees with the rules and is prepared to enforce
them.
2. Monitor your teen’s activity: Know where your teen goes and who he or she hangs out
with. Remove or lock away alcohol from your home and routinely check potential hiding
places for alcohol—in backpacks, under the bed, between clothes in a drawer, for
example. Explain to your teen that this lack of privacy is a consequence of him or her
having been caught using alcohol.
3. Encourage other interests and social activities. Expose your teen to healthy hobbies
and activities, such as team sports, Scouts, and afterschool clubs.
4. Talk to your child about underlying issues. Drinking can be the result of other
problems. Is your child having trouble fitting in? Has there been a recent major change,
like a move or divorce, which is causing stress?
5. Get Help: You don’t have to go it alone. Teenagers often rebel against their parents but if
they hear the same information from a different authority figure, they may be more
inclined to listen. Try seeking help from a sports coach, family doctor, therapist, or
counselor.
6. Real Causes of Alcoholism: Still Unknown, a Social & Medical Problem
7. Posted in Category : Men's Health | March 10, 2008
8. Alcoholism has been prevalent and has been one of the greatest social and medical
problems in many countries around the world. One of the reasons for this is because its
causes are not really well-established. There are growing assumptions about the causes of
alcoholism but up to this time, these assumptions and theories are still controversial
subject for researches and studies.
9. Drinking alcohol is a very common part of lifestyle. There are some countries in the
world which are very well known for having alcohol drinking as part of their culture. It is
argued that culture can be one of the causes of alcoholism however there are not enough
evidences for this. Aside from culture, there are other factors that are associated with the
causes of alcoholism. Some of these factors are society influence, alcohol availability,
family and peer pressure, stress level and other psychological factors. Accordingly, these
factors have more influence in the emotional and mental being of an individual. Drinking
alcohol may be a habit for fun, relaxation, stress relief and to some, they consider this to
be a temporary escape from their problems.
10. Unlike other types of diseases where the causes are known and proven by certain
evidences, the causes of alcoholism remain to be cloudy to many doctors, psychologists
and psychiatrists. Despite the attempts to dig deeper on what really cause a person to be
alcoholic, there are only four factors that are proven to have big influence on the
prevalence of the said disease.
11. One of the causes of alcoholism that is said to have a big influence in developing the
disease is genetics. Accordingly, genes present in an individual can influence a person to
be very susceptible to alcohol dependence, abuse or alcoholism. Another factor that is
said to cause alcoholism is the emotional state of an individual. Stress, insecurity,
disappointment, anxiety greatly influence a person to drink alcohol to temporarily stop
the turmoil brought by emotional state. This emotional state of an individual is associated
with psychological factors which are also considered to influence the level of alcoholism.
The last factor that is associated with alcoholism is the cultural and social factors. Some
of the things under this factor are peer pressure, social events and parties that may require
a person to drink too often.
12. Even though the research about what the real causes of alcoholism are, people drinking
alcohol should never be relaxed thinking that their habit will not do them any harm.
Know yourself well and ask yourself, are you drinking more than the usual? Are you
drinking too often that you are going beyond modesty? If your answers to this question
are yes, see your doctor and discuss with him the different treatment options you may opt
to take.
13. Once established, an alcohol addiction diagnosis does not offer any information about
the type, causes, and stage of the problem. Recent studies suggest that alcoholism is
a complex physical-psychicological malady.
People from different social classes with different professions can develop an alcohol
addiction.

Alcohol addiction is caused by psychosomatic, social and ideologic problems or


better said by a complexed interaction between psychological and physical
features, a certain enviroment, and a specific attitude towards life.
14.However, alcohol addiction may develop, but is not certain.
A person can slide from a conflictual
situation into a disease, a suicide
attempt, addiction or immoral acts.
This can be triggered by several
experiences, certain behaviors, a
disturbed emotional analyze, a
disagreement between the will forces
and the strong desire to solve a
tensed, unbearable conflict, and/or a
lack of adjusting skills.
However, we cannot conclude
that alcohol
15.addiction is caused by determining factors that "push" the person into an
excessive drinking.
16. The progress of the alcohol addiction is determined by the individual's character,
emotions and behavior.

However, each alcoholic is responsible for their life even when the
enviroment playes a major influence on the addiction onset and progress.

When the alcoholic refuses to be responsible for what they become and for their
addiction, and continues to consider themself the victim of the society and
circumstances, they will end in a situation without solutions. Only when they initiate
behavioral and attitude changes, their efforts and the effort of their family, friend or
counselors will lead to a successful otucome. Only in this conditions, the alcoholic can
start working on their problem by focusing on the causes that lead to the
development of the addiction.

Hereditary causes

Alcoholism is not a genetic condition. However, all those that have a family
history of alcohol related problems should be as cautious of approaching alcohol as a
hereditary diabetics is with sugar.

Alcoholism is not inherited like the blue color of the eyes or other genetic disorders.
However, it is also known that some families have more members alcoholics than
others.
According to an American study, children of alcoholic families have a four time the
risk to become addicted to alcohol than children from non-alcholic families. However,
each person reacts different to alcohol, but the tolerance toward alcohol seems to be
inherited (statement proved by studies conducted on twins from different rases.)
17. We can also talk about a so called social inheritance. Childrens from alcoholic
families are exposed to alcohol-related experiences that are considered normal in
their family environment. An outside person can think that these experiences would
not affect the child's further development. The reality is different.
18. Several researches suggest that, in general, boys with alcoholic fathers are more
tolerant to alcohol than other boys. Also, alcoholics come from families where the
mothers experienced long periods of depression.

According to a study, American researchers claim that adults that have


alcoholic parents are different than adults with non-alcoholic parents. This
difference is emphasised by the following characteristics:

» They don't know what means to behave normally and they guide themselves after
others.
» They have difficulties following a plan from the begining to the end.
» They lie even when is lot simple to say the truth.
» They critically judge themselves.
» They have hard time to relax (when things go well for a while, they start to
become anxious)
» They take themself very serious.
» They experience difficulties in their personal relationships (fear of being
abandoned)
» They become overexcited when facing environmental modifications, expecialy
when they cannot control them.
» They constantly seek for external support and validation.
» They consider themselves different from others.
» They are either extremly conscientious, or extremly irresponsible.
» They are extremly faithful and loyal, even when their loyality is not appreciated.
» They are impulsive. They tend to get stocked in actions without a previous analyze
of the alternatives and consequences.

However, this does not mean that all children with alcoholic parents will
become alcoholics.

Somatic (body) causes

There are no somatic factors that cause alcohol addiction. There is no allergy to
alcohol that ca trigger the addiction when the body comes in contact with a small
amount of alcohol.
19.It is more dangerous when people only react positively to the alcohol
without experiencing unpleasant follow-ups.
20. Several studies suggest that those individuals that have a decreased amount of
endorphin (a substance similar with morphine that regulates the mood which is
synthesized by the body) react positively to alcohol, and they appreciate it more.

An increased alcohol consumption for long periods of time affects the normal function
of the liver. When exposed to high amounts of alcohol for long periods of time, the
liver starts to process the alcohol through an additional catabolism mechanism called
microzonale ethanol oxidation system. This additional mecahism catabolises
more than two thirds of the ingested alcohol. That is on of the reasons why alcoholics
can handle a higher amount of alcohol than normal people. However, this addictional
catabolism mechanism will continue to function even after long periods of abstinence
causing the craving sensations that each sober alcoholic experiences. Due to this
mechanism, alcoholics cannot return to a normal alcohol consumption.
21. Another explanation offered recently by other researchers is that when the alcohol is
metabolised, several chemicals (which are the result of the adrenalin, dopamin, and
acetaldehyde condensation) known as condensation products are released in the
brain. These substances target the same receptors as opiates. The brain areas where
these substances operate regulate and control the mood and the psychological
comfort.
22. A chronic, abusive alcohol consumption reduces with 50 percent the endorphins
concentration in the brain. Endorphins are essential for maintaining an invigorated
state of mental health.

Psychological causes

There are no specific features that profile the image of an alcoholic. However, there
are several characteristics that are common among alcoholics. These are:

» The tendency to avoid problems despite the person ability to solve them.
» Personal uncertainty and inhibition.
» High need to depend on others.
» Decreased ability to cope with dissatisfaction, to be composed, or to postpone an
instant gratification (low level of tolerance to frustation).
» An exaggerate self-control and suppression.
» Difficulties in satisfying their attachment and closeness needs.
» They often experience bad moods and a reduced psychical state of comfort.

However, all these characteristics can also be a consequence of an abusive


drinking.

In many cases, the addiction is treated with unsuccessful attemps of self-medication


to fix inner discomfort. Females often suffer from psychological wounds caused by
sexual abuse or aggression. A higher number of alcoholics were raised in orphanages
or in disfunctional/disorganized families. However, psychological wounds are not an
essential or sufficient condition for an alcohol addiction to develop.
23. Unfortunately, a major role in the onset and progress of an addiction is played by the
individual's attitude towards life and not so much their personality features. Most
alcoholic live their life constantly waiting for something better to happen, and believe
that life is a constant ascension. In reality, life follows an up-and-down pattern. An
alcoholic tries to chemically equalise these ups and downs and even tries to improve
the quality of their life. However, on long term, this effort has an oppsite effect.
24. Professional causes

There are significant differences between the number of alcoholics from different
professional groups. Individuals that work so called "alcoholic jobs", such as
producers and distributers of alcholic beverages, have a high risk to become
alcoholics.
Also, those that work in contructions, transportation (especially sailors), self-
employed individuals with a flexible work schedule, or those that have jobs either
with lot of routine tasks or without constant supervision, are more exposed to alcohol
consumption and are more vulnerable to develop an alcohol addiction.
25. When the job solicits and over-solicits the individual, they will try to cope with the
stress by drinking.

It is also very important to have an education and a safe job that fits your needs.
Unemployment is a major stress factor that can lead to abusive drinking.

Those women that face a higher risk to develop an alcohol addiction are the staying
home wives, especially those with a good social and economical situation.

Educative causes

Those parents that did not have any contribution or played an insignificant role in
their children's alcohol addiction evolution, experience guit feelings and are tortured
by doubts. Some believe that they spoiled the children too much, they suffocated
them with too much love; others think that they had been too severe, too cold,
restricted their children's freedom, or rejected them too much. An environment
where the children is excessively protected and is raised to be dependent on others
is also harmful.
Each of these education styles could contribute to the onset and evolution of the
addiction.
However, is impossible to find a cause-effect type answer. All these worries and fears
can be effective as long as they help to understand and solve the problem.
26. The situation seems to be easier when those individual raised by alcoholic parents,
when the life leason achieved through childhood is that problems can be defeated
with alcohol. Even if the children experienced negatively their parent alcoholism,
they might follow the same pattern in order to solve their problems.

Conflictual causes

Every family or jobs conflict can lead to an abusive drinking. However, an abusive
drinking can also be the cause for many familial and professional problems, which
can complicate more the situation. The individual will strongly want to avoid these
conflicts but they actually build a vicious circle. This cicle will become stronger and
stronger in time and request tremendous effort to be stopped.

A closer examination of this situation reveals that the addiction is not caused by the
conflict, but by the individual coping maner. The conflict can be either approched and
solved, or avoided. So, not the conflict is the problem, but the approaching
maner. One thing is sure, alcohol is not an effectice solution to deal with conflicts.

Social causes

The society's attitude towards alcohol and alcoholics is equivocal. While the alcoholic
is despised for drinking too much, those that can drink high amounts of alcohol at a
party are admired. Drinking high amounts of alcohol is also perceived as a
masculinity sign. A real man is the one that can handle high amounts of alcohol. In
opposition to the strong men is the weak one, which either drinks small amount of
alcohol or does not drink at all.
27. Unfortunately, the society accepts the alcohol consumption and unwillingly promotes
the alcohol addiction. When the negative effect of drinking alcohol is underestimated,
the society helps the person facing an alcohol addiction to not see the real danger
they are actually facing.