According to recent estimates from the federal
government's National Institute on Alcohol Abuse and
Alcoholism, 6% of men and 3% of women were alcoholics. That
translates to nearly 8 million alcoholics in the United
States. As many as 1.5 million of them seek treatment each
year. Some enroll in inpatient and outpatient alcoholism
treatment programs and supplement that with regular attendance
at AA and other self help group meetings. Others find success
with AA and similar self help groups alone. Some turn to
psychotherapy. Some quit drinking completely on their own.
Alcoholism is a complex disease with physical,
social and psychological consequences; not only for alcoholics
but also for people closest to them. In the past, alcoholism
was often viewed as a moral weakness or character flaw; it was
thought that the person could stop drinking if he or she
really wanted to. It wasn't until 1970, that people began to
understand and accept that alcoholism is a life threatening,
chronic disease involving psychological and physical
dependence on alcohol.
Based on the
American Psychiatric Association's 4th edition of Diagnostic
and Statistical Manual of Mental Disorders, NIAAA recognizes
four signs of alcoholism
- Loss of control
over drinking. Alcoholics may intend to have two or three
drinks, but before they know it, they are on their 10th.
- Continued use
of alcohol despite social, medical, family, and work
alcohol tolerance over time, i.e. needing more alcohol to
symptoms when alcoholics stop drinking after a period of
heavy drinking. The symptoms include anxiety, agitation,
increased blood pressure, and, in extreme cases, seizures.
These symptoms may persist for several days.
People do not need
to have all four signs to be diagnosed as alcoholic. Those who
have significant problems controlling their drinking and
functioning in social situations because of alcohol may be
considered alcoholics without the physical signs, tolerance
There is a
distinction between alcoholism and alcohol abuse. The latter
is a less severe problem; unlike alcoholics, alcohol abusers
do not develop physical withdrawal or compulsive alcohol use.
However, like alcoholics, their drinking has negative health,
economic and social effects. Both alcoholics and alcohol
abusers need treatment, although the goals differ. In most
cases of alcohol abuse, the goal is to limit drinking, while
for alcoholism, it is to stop drinking altogether.
Why some people
become alcoholics remains a mystery, although most scientists
now agree that a combination of genetic and environmental
factors increases a person's vulnerability.
divide alcoholism into two types. Type I, the most common,
occurs in both men and women and is associated with adult
onset alcohol dependence. This form, also known as milieu
limited alcoholism, appears to be the result of genetic
predisposition and environmental provocation, that is, the
development of alcoholism in these cases is an interaction
between inherited predisposition and the person's life
Type II, or male
limited, alcoholism, on the other hand, is due mainly to
genetics. It occurs only in men, usually with early onset in
the teen years, and is more difficult to treat. Type II
alcoholics tend to exhibit antisocial, aggressive behavior. It
has been suggested that there may be a third type similar to
Type II but without the antisocial behavior.
realize a friend or family member has alcoholism through the
consequences of drinking, such as arrests for drunk driving or
problems at work, including chronic absenteeism. Alcoholics'
spouses may demand they leave the house. Later in the disease,
they may be hospitalized for liver disease or pancreatitis.
Denial of these and other negative
effects of alcohol in their lives is common in alcoholics and
those close to them. But sometimes the negative occurrences
can serve as a catalyst for getting the alcoholic into
treatment. Usually, an illness or ultimatum from the spouse or
other family member, boss, doctor, or judge is the driving
For some alcoholics, treatment begins with
"detoxification". which is the medical management of acute
alcohol withdrawal. This can be done in the hospital or on an
outpatient basis and usually lasts one to seven days. This can
also be done with a private program, such as this
The FDA has
approved two antianxiety drugs, Valium (diazepam) and Librium
(chlordiazepoxide), for treating alcohol withdrawal effects.
Some doctors also prescribe other drugs in the same chemical
class, also approved to treat anxiety. These drugs help
decrease the symptoms of alcohol withdrawal, including anxiety
and tremors, and reduce the risk of serious consequences of
withdrawal, such as seizure and delirium. Dosages are based on
the severity of patients' symptoms. Use of these drugs beyond
the withdrawal phase is not advised for alcoholics because of
the drugs' abuse potential and alcoholics' addictive
patients can begin rehabilitation. While enrolled, patients
attend classes and participate in individual, group and family
counseling sessions. The activities aim to educate patients
about alcoholism, help them recognize that they have the
disease, and help them adjust to a life without alcohol.
Patients often are introduced to self help groups, such as AA.
Family members often get involved, too, and may be referred to
Al-Anon, a self help group for family members of alcoholics.
intensive program, patients are often encouraged to continue
with some type of aftercare program for at least one year.
This might include AA, individual or group psychotherapy, or a
sponsored program that continues on a smaller scale the same
type of activities offered during the intensive treatment.
may be helped in their recovery with one of two drugs approved
for discouraging alcohol intake. Antabuse (disulfiram), when
combined with even small amounts of alcohol causes unpleasant
effects such as facial flushing, throbbing headache, nausea,
vomiting, and increased blood pressure and heart rate. The
drug's effectiveness depends on patient motivation. Those who
want to drink simply stop taking the drug.
A 1986 study found
that Antabuse did not improve abstinence rates, length of time
to relapse, or psychosocial functioning any more than
counseling alone. But, patients on Antabuse who continued to
drink drank less frequently than relapsed patients who did not
receive the medication.
The second drug,
ReVia (naltrexone), acts on the opioid receptors in the brain
to help prevent relapse and reduce alcohol cravings in those
who drink. In a 12 week study of 70 alcoholic men, 23% of the
ReVia treated patients relapsed, compared with 54% of those
receiving placebo. Of those who drank during the study, 50% of
those on ReVia relapsed to heavy drinking, compared with 95%
of those receiving placebo. A separate study of 104 alcoholic
men and women found that patients who took ReVia were about
twice as successful in quitting drinking as patients who
ReVia was tested in conjunction with supportive therapy, FDA
approved its use only as an adjunct to supportive therapy
(such as group therapy) in treating alcoholism. Studies show
the drug is nonaddictive. But it can cause liver toxicity when
given at doses higher than recommended. Therefore, it is not
recommended for people with active hepatitis and other liver