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Alcoholism, also known as alcohol dependence, is a disease that includes the following four symptoms: - Craving--A strong need, or urge, to drink. - Loss of control--Not being able to stop drinking once drinking has begun. - Physical dependence--Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping
drinking. - Tolerance--The need to drink greater amounts of alcohol to get "high." For clinical and research purposes, formal diagnostic criteria for alcoholism also have
been developed. Such criteria are included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, published
by the American Psychiatric Association, as well as in the International Classification Diseases, published by the World
Health Organization. (See also "Publications," Alcohol
Alert No. 30: Diagnostic
Criteria for Alcohol Abuse and Dependence.) Yes, alcoholism is a disease. The craving that an alcoholic feels for alcohol can be as strong as the need for food or water.
An alcoholic will continue to drink despite serious family, health, or legal problems. Like many other diseases, alcoholism is chronic, meaning that it lasts a person's
lifetime; it usually follows a predictable course; and it has symptoms. The risk for developing alcoholism is influenced both by a
person's genes and by his or her lifestyle. (See also "Publications," Alcohol
Alert No. 30: Diagnostic
Criteria for Alcohol Abuse and Dependence.) Research shows that the risk for developing alcoholism does indeed run in families. The genes a person inherits partially
explain this pattern, but lifestyle is also a factor. Currently, researchers are working to discover the actual genes that put
people at risk for alcoholism. Your friends, the amount of stress in your life, and how readily available alcohol is also are
factors that may increase your risk for alcoholism. But remember: Risk is not destiny. Just because alcoholism tends to run in families
doesn't mean that a child of an alcoholic parent will automatically become an alcoholic too. Some people develop alcoholism even
though no one in their family has a drinking problem. By the same token, not all children of alcoholic families get into trouble
with alcohol. Knowing you are at risk is important, though, because then you can take steps to protect yourself from developing
problems with alcohol. (See also "Publications," Alcohol
Alert No. 18: The
Genetics of Alcoholism.) No, alcoholism cannot be cured at this time. Even if an alcoholic hasn't been drinking
for a long time, he or she can still suffer a relapse. To guard against a relapse, an alcoholic must continue to avoid all
alcoholic beverages. (See also "Publications/Pamphlets and Brochures," Alcoholism:
Getting the Facts.) Yes, alcoholism can be treated. Alcoholism treatment programs use both counseling and
medications to help a person stop drinking. Most alcoholics need help to recover from their disease. With support and treatment,
many people are able to stop drinking and rebuild their lives. (See also "Publication," Alcohol
Alert No. 49: New
Advances in Alcoholism Treatment.) A range of medications is used to treat alcoholism. Benzodiazepines (Valium® , Librium®) are sometimes
used during the first days after a person stops drinking to help him or her safely withdraw from alcohol. These medications are
not used beyond the first few days, however, because they may be highly addictive. Other medications help people remain sober. One
medication used for this purpose is naltrexone (ReVia™). When combined with counseling naltrexone can reduce the craving for
alcohol and help prevent a person from returning, or relapsing, to heavy drinking. Another medication, disulfiram (Antabuse®),
discourages drinking by making the person feel sick if he or she drinks alcohol. Though several medications help treat alcoholism, there is no "magic bullet."
In other words, no single medication is available that works in every case and/or in every person. Developing new and more
effective medications to treat alcoholism remains a high priority for researchers. (See also "News Releases," Jan.
17, 1995: Naltrexone
Approved for Alcoholism Treatment and "Publication," Alcohol
Alert No. 33: Neuroscience Research and Medications Development.) Alcoholism treatment works for many people. But just like any chronic disease, there are varying levels of success when it
comes to treatment. Some people stop drinking and remain sober. Others have long periods of sobriety with bouts of relapse. And
still others cannot stop drinking for any length of time. With treatment, one thing is clear, however: the longer a person
abstains from alcohol, the more likely he or she will be able to stay sober. No. Alcoholism is only one type of an alcohol problem. Alcohol abuse can be just as
harmful. A person can abuse alcohol without actually being an alcoholic--that is, he or she may drink too much and too often but
still not be dependent on alcohol. Some of the problems linked to alcohol abuse include not being able to meet work, school, or
family responsibilities; drunk-driving arrests and car crashes; and drinking-related medical conditions. Under some circumstances,
even social or moderate drinking is dangerous--for example, when driving, during pregnancy, or when taking certain medications.
(See also "Publications/Pamphlets and Brochures," Alcoholism:
Getting the Facts.) Alcohol abuse and alcoholism cut across gender, race, and nationality. Nearly 14 million
people in the United States--1 in every 13 adults--abuse alcohol or are alcoholic. In general, though, more men than women are
alcohol dependent or have alcohol problems. And alcohol problems are highest among young adults ages 18-29 and lowest among adults
ages 65 and older. We also know that people who start drinking at an early age--for example, at age 14 or younger--greatly
increase the chance that they will develop alcohol problems at some point in their lives. (See also "News Releases," March
17, 1995: NIAAA
Releases Estimates of Alcohol Abuse and Dependence and Alcohol Alert No. 23: Alcohol
and Minorities.) Answering the following four questions can help you find out if you or a loved one has a drinking problem: One "yes" answer suggests a possible alcohol problem. More than one "yes" answer means it is highly likely
that a problem exists. If you think that you or someone you know might have an alcohol problem, it is important to see a doctor or
other health care provider right away. They can help you determine if a drinking problem exists and plan the best course of
action. It depends. If that person has been diagnosed as an alcoholic, the answer is
"no." Alcoholics who try to cut down on drinking rarely succeed. Cutting out alcohol--that is,
abstaining--is usually the best course for recovery. People who are not alcohol dependent but who have experienced alcohol-related
problems may be able to limit the amount they drink. If they can't stay within those limits, they need to stop drinking
altogether. (See Question 13
which addresses the issue, "What is a safe level of drinking?") (See also "Publications/Pamphlets and
Brochures," How to Cut Down on
Your Drinking.) This can be a challenge. An alcoholic can't be forced to get help except under certain circumstances, such as a violent
incident that results in court-ordered treatment or medical emergency. But you don't have to wait for someone to "hit rock
bottom" to act. Many alcoholism treatment specialists suggest the following steps to help an alcoholic get
treatment: Stop all "cover ups." Family members often make excuses to others or try to protect the alcoholic from
the results of his or her drinking. It is important to stop covering for the alcoholic so that he or she experiences the full
consequences of drinking. Time your intervention. The best time to talk to the drinker is shortly after an alcohol-related problem has
occurred--like a serious family argument or an accident. Choose a time when he or she is sober, both of you are fairly calm, and
you have a chance to talk in private. Be specific. Tell the family member that you are worried about his or her drinking. Use examples of the ways in
which the drinking has caused problems, including the most recent incident. State the results. Explain to the drinker what you will do if he or she doesn't go for help--not to punish the
drinker, but to protect yourself from his or her problems. What you say may range from refusing to go with the person to any
social activity where alcohol will be served, to moving out of the house. Do not make any threats you are not prepared to carry
out. Get help. Gather information in advance about treatment options in your community. If the person is willing to
get help, call immediately for an appointment with a treatment counselor. Offer to go with the family member on the first visit to
a treatment program and/or an Alcoholics Anonymous meeting. Call on a friend. If the family member still refuses to get help, ask a friend to talk with him or her using the
steps just described. A friend who is a recovering alcoholic may be particularly persuasive, but any person who is caring and
nonjudgmental may help. The intervention of more than one person, more than one time, is often necessary to coax an alcoholic to
seek help. Find strength in numbers. With the help of a health care professional, some families join with other relatives
and friends to confront an alcoholic as a group. This approach should only be tried under the guidance of a health care
professional who is experienced in this kind of group intervention. Get support. It is important to remember that you are not alone. Support groups offered in most communities
include Al-Anon, which holds regular meetings for spouses and other significant adults in an alcoholic's life, and Alateen, which
is geared to children of alcoholics. These groups help family members understand that they are not responsible for an alcoholic's
drinking and that they need to take steps to take care of themselves, regardless of whether the alcoholic family member chooses to
get help. (See Question 19 for referral to support groups.) You can call the National Drug and Alcohol Treatment
Referral Routing Service (Center
for Substance Abuse Treatment) at 1-800-662-HELP for information about treatment
programs in your local community and to speak to someone about an alcohol problem. For most adults, moderate alcohol use--up to two drinks per day for men and one drink per day for women and older
people--causes few if any problems. (One drink equals one 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or
1.5 ounces of 80-proof distilled spirits.) Certain people should not drink at all, however: (See also "Publications" Alcohol
Alert No. 16: Moderate Drinking; Alcohol
Alert No. 27: Alcohol-Medication
Interactions; Alcohol Alert No 50:
Fetal Alcohol Exposure and the Brain; and Alcohol
Alert No. 52: Alcohol and Transportation Safety) No, drinking during pregnancy is dangerous. Alcohol can have a number of harmful effects
on the baby. The baby can be born mentally retarded or with learning and behavioral problems that last a lifetime. We don't know
exactly how much alcohol is required to cause these problems. We do know, however, that these alcohol-related birth defects
are 100-percent preventable, simply by not drinking alcohol during pregnancy. The safest course for women who are pregnant or
trying to become pregnant is not to drink alcohol at all. (See also "Publications" Alcohol
Alert No.50: Fetal
Alcohol Syndrome and the Brain; "Pamphlets and Brochures," Drinking
and Your Pregnancy.) Alcohol's effects do vary with age. Slower reaction times, problems with hearing and seeing, and a lower tolerance to alcohol's
effects put older people at higher risk for falls, car crashes, and other types of injuries that may result from drinking. Older people also tend to take more medicines than younger people. Mixing alcohol with
over-the-counter or prescription medications can be very dangerous, even fatal. More than 150 medications interact harmfully with
alcohol. (See Question 18 for more information.) In
addition, alcohol can make many of the medical conditions common in older people, including
high blood pressure and ulcers, more serious. Physical changes associated with aging can make older people feel "high"
even after drinking only small amounts of alcohol. So even if there is no medical reason to avoid alcohol, older men and women
should limit themselves to one drink per day. (See also "Publications/Pamphlets and Brochures" Age
Page: Aging and Alcohol Abuse and Alcohol
Alert No. 40: Alcohol and Aging.) Yes, alcohol affects women differently than men. Women become more impaired than men do
after drinking the same amount of alcohol, even when differences in body weight are taken into account. This is because women's
bodies have less water than men's bodies. Because alcohol mixes with body water, a given amount of alcohol becomes more highly
concentrated in a woman's body than in a man's. In other words, it would be like dropping the same amount of alcohol into a much
smaller pail of water. That is why the recommended drinking limit for women is lower than for men. (See Question
13 for recommended limits.) In addition, chronic alcohol abuse takes a heavier physical toll on women than on men.
Alcohol dependence and related medical problems, such as brain, heart, and liver damage, progress more rapidly in women than in
men. (See also "Publications," Alcohol
Alert No. 46: Are Women
More Vulnerable to Alcohol's Effects.) Studies have shown that moderate drinkers--men who have two or less drinks per day and women who have one or less drinks
per day--are less likely to die from one form of heart disease than are people who do not drink any alcohol or who drink
more. It's believed that these smaller amounts of alcohol help protect against heart disease by changing the blood's chemistry,
thus reducing the risk of blood clots in the heart's arteries. If you are a nondrinker, however, you should not start drinking solely to benefit your heart. You can guard against heart
disease by exercising and eating foods that are low in fat. And if you are pregnant, planning to become pregnant, have been
diagnosed as alcoholic, or have another medical condition that could make alcohol use harmful, you should not drink. If you can safely drink alcohol and you choose to drink, do so in moderation. Heavy
drinking can actually increase the risk of heart failure, stroke, and high blood pressure, as well as cause many other medical
problems, such as liver cirrhosis. (See also "Publications," Alcohol
Alert No. 16: Moderate
Drinking and Alcohol Alert No. 45: Alcohol Coronary Heart Disease.) Possibly. More than 150 medications interact harmfully with alcohol. These interactions
may result in increased risk of illness, injury, and even death. Alcohol's effects are heightened by medicines that depress
the central nervous system, such as sleeping pills, antihistamines, antidepressants, anti-anxiety drugs, and some
painkillers. In addition, medicines for certain disorders, including diabetes, high blood pressure, and heart disease, can
have harmful interactions with alcohol. If you are taking any over-the-counter or prescription medications, ask your doctor
or pharmacist if you can safely drink alcohol. (See also "Publications,"
Alcohol Alert No. 27: Alcohol-Medication
Interactions.) There are many national and local resources that can help. The National Drug and Alcohol
Treatment Referral Routing Service provides a toll-free telephone number, 1-800-662-HELP, offering various resource information.
Through this service you can speak directly to a representative concerning substance abuse treatment, request printed material on
alcohol or other drugs, or obtain local substance abuse treatment referral information in your State. See (Treatment
Referral Information.) Many people also find support groups a helpful aid to recovery. The following list includes a variety of resources: Al-Anon/Alateen
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