Alcoholism

 
Put most simply, alcoholism is a disorder involving physical dependence on alcohol. This physical dependence results in uncontrollable cravings for alcohol, an inability to control drinking, the onset of withdrawal symptoms if drinking is stopped, and tolerance, which means that the body has become accustomed to certain levels and needs more alcohol to achieve the same effect that was originally reached with less.

Alcoholism is just one level of alcohol abuse disorders, which affect approximately 18 million adults in the US. These issues have the potential to cause many levels of physical, mental, and social harm both for the people who have alcohol use disorders and for their loved ones and even strangers.

 

The relaxing effects of alcohol are caused by the fact that it affects the central nervous system, suppressing several areas of brain activity that have different results. The areas of the brain affected include the:

• Cerebral cortex: Alcohol’s effects on this area result in loss of inhibition and slowed sensory and thought processes.
• Cerebellum: Movement and balance are affected through this area of the brain, resulting in clumsiness and staggering.
• Medulla: This part of the brain handles unconscious processes like breathing, consciousness, and body temperature; if these areas are affected enough, the result can be life-threatening.
• Hypothalamus and pituitary: The effects that alcohol has on these hormone centers can cause issues with hormone production and sexual performance.

These effects become more pronounced the more alcohol is consumed, resulting in the familiar symptoms of drunkenness, which include:

Over the long-term, continued heavy alcohol consumption can lead to more severe symptoms. Those who abuse alcohol or who have developed alcoholism are susceptible to a wide range of physical and mental health issues that can have serious health effects.

 

After years of heavy use related to alcoholism, the effects of alcohol on the body can include damage to major organs, such as:

• Brain changes that permanently damage the ability to think, as well as movement and speech
• Heart damage that can lead to high blood pressure and arrhythmia, resulting in stroke
• Development of various liver issues, such as fatty liver, hepatitis, or cirrhosis
• Additional problems with the pancreas, the immune system, and other systems

Alcoholism can increase the risk of many cancers, including the mouth, throat, esophagus, liver, and breast.

 
One further set of effects that alcohol has on the body, especially as a result of an alcohol use disorder, is alcohol withdrawal. When tolerance and dependence are reached, the body reacts badly if the alcohol is removed. Alcohol withdrawal symptoms range from mildly uncomfortable to potentially life-threatening. They include:

The degree to which these symptoms are experienced is based on the degree of the abuse or addiction. DTs is the most dangerous withdrawal symptom; people who exhibit DTs become delirious and may hallucinate, feel severely confused and agitated, and have fever, as well as potential seizures.

Treatment can help to minimize both the danger and the discomfort of alcohol withdrawal symptoms. With a doctor’s supervision, medicines and therapy can help a person get through withdrawal and continue on to management and recovery from an alcohol use disorder.

 

• As reported by the National Institute of Alcohol Abuse and Alcoholism, according to the Substance Abuse and Mental Health Services Administration’s most recent study, about 87 percent of people 18 and over have consumed alcohol at some point in their lives.
• Of people aged 18 and over in 2013, 6 percent engaged in at least one binge drinking event (five or more beverages at the same time or within about two hours), and 6.8 percent engaged in heavy drinking (binge drinking more than five days in a 30-day period) in 2012-2013.
• More than 16,600 people had a substance abuse disorder related to alcohol in 2012-2013. Nearly twice as many men had this type of disorder compared to women.
• Alcohol abuse is not just an adult issue. Of people between the ages of 12 and 17, 56.4 percent had consumed alcohol within the previous month, 6.2 percent had at least one binge drinking event, and 1.2 percent engaged in heavy drinking.
• Excessive alcohol use led to approximately 88,000 deaths each year between 2006 and 2010, according to the Centers for Disease Control and Prevention. Alcohol was responsible for about one in 10 deaths of people aged 20-64.
• The economic cost of excessive alcohol use in 2010 alone was estimated at $249 billion. About two-fifths of this cost was paid for by government, which means the money came from taxpayers.
• Treatment improves recovery rates. According to one study, 4 percent of people who get help or treatment for alcoholism remained in recovery for three years, compared with only 43.4 percent of those who received no help. Of the latter group, 60.5 percent had relapsed by 16 years post treatment, compared with only 42.9 percent of those who had received treatment or help.

 
Most of the people who engage in binge drinking are not alcoholics. In fact, only about 10 percent of binge drinkers also struggle with alcoholism. However, the more frequently a person binge drinks, the higher the likelihood of alcoholism; of those who binge drink more than 10 times per month, 30 percent are also dealing with alcoholism.

Even though most binge drinkers do not have alcoholism, they still have increased health risks similar to those of people who are struggling with alcoholism. These include:

• Increased risk of heart and liver diseases
• Brain and neurological damage
• Fetal alcohol syndrome
• Unintentional or intentional injury
• Mental health disorders and diminished cognitive functioning

While those who binge drink may not need full treatment for their substance abuse disorders, they can be encouraged through various programs and methods to understand the risks of binge drinking and learn to curb their binges.

 
There are signs that can indicate that a person’s alcohol use has crossed the line into an alcohol use disorder like alcoholism that requires treatment. These signs include:

• Drinking more or longer than intended
• Being unable to cut down on drinking, even if wanting to
• Getting into risky situations while drinking or drunk
• Having to drink more than previously required to get the desired effect
• Continuing to drink even in the face of adverse physical, psychological, and personal effects
• Having legal or relationship troubles due to drinking
• Missing out on favorite activities because of drinking
• Experiencing the withdrawal symptoms described above if drinking is stopped

A person struggling with alcoholism may have any or all of these symptoms. When individuals or their loved ones recognize these symptoms, it is time to get help.

 
Research has shown that the treatment that is most likely to help a person struggling with alcoholism is a comprehensive program tailored to that person’s particular needs. These types of programs ideally include the following elements:

• Medically assisted detox to help minimize the risk and discomfort of withdrawal
• If needed, medically supported treatments to prevent cravings
• Behavioral modification therapy to help a person manage and avoid triggers and cravings
• Family and interpersonal therapy to build, heal, and rebuild social support for recovery
• Provision of tools and strategies to avoid situations that may lead to relapse
• Introduction to support groups and other motivational means to help maintain recovery after treatment

Customizing these therapies and treatments to meet the individual’s specific requirements is more likely to result in a positive outcome.

For example, co-occurring mental health disorders can be both contributing factors and result from alcoholism. Because of this, a person who is dealing with a dual diagnosis, such as depression or another mental health disorder along with alcohol addiction, is more likely to achieve and maintain recovery if the symptoms of that disorder are treated alongside the alcoholism.

 
Research has shown that people who remain in treatment for three months or longer are more likely to remain abstinent from alcohol for the long term after treatment. Because of this, and because of the fact that a well-rounded, intensive treatment program as described above is most likely to result in long-term recovery, an inpatient rehab program is the type of treatment most recommended by experts.

Inpatient treatment programs are able to work with individuals struggling with alcoholism to meet individual needs. This type of program provides the elements of successful treatment that are most likely to support recovery both during and after treatment. In addition, residential treatment provides 24-hour, seven-day support throughout the treatment process. The most helpful programs also provide resources and tools for support after rehab is over, including motivational support to help clients maintain recovery after the treatment program is complete.

 
According to experts, the most important element of treatment and post-treatment for alcoholism is for the person who is being treated to be committed to recovery. Being serious about aftercare once the treatment program is complete can help a person maintain recovery for the long term. Various aftercare elements that contribute to this capability include:

• Post-treatment therapy is one of the main aftercare strategies. This can help the individual maintain commitment to treatment tools and keep up the motivation that helped to begin and stay with treatment.
• Participation in a mutual support group like Alcoholics Anonymous. This kind of participation has been shown to reduce relapse in people who attend meetings after treatment.
• Motivational Interviewing is an aftercare program, by which treatment centers keep in contact with the client to give motivational support and check in with progress post rehab. This kind of care has been shown to help maintain recovery, and it is particularly helpful for those with dual diagnoses.
• Family and interpersonal therapy help to form a social support structure that can hold the individual accountable for maintaining recovery. This therapy also helps to rebuild relationships that were damaged during active addiction.
• Activities and social structures that support recovery can help an individual form a firmer foundation in recovery. These can include spending time with friends who support the individual’s recovery goals, rather than those who enable or who may represent triggers for alcohol use.
• Know that oftentimes relapse is part of the recovery process. While it is hoped that relapse will be avoided, alcoholism is a chronic illness, not unlike diabetes and asthma, and relapse is part of the process. Relapse should not be seen as a failure either by the individual or by loved ones; rather, it is an opportunity to renew one’s commitment to recovery and reinforce treatment and post-treatment tools and strategies.

FAQs

• What are the signs of an alcohol problem?

  The signs of alcoholism revolve around whether or not the person’s drinking negatively affects mental, physical, and social health and behavior. These signs include:

  • Being unable to stop drinking, even when it harms health, work, and relationships
  • Having intense cravings for alcohol
  • Engaging in risky behavior while or after drinking
  • Having legal, financial, or job-related problems because of drinking
  • Experiencing increasing physical or mental health issues along with long-term drinking
  • Giving up activities that used to be enjoyed because of drinking

• Is binge drinking a sign of alcoholism?

  Most people who engage in binge drinking behavior do not have a problem with alcoholism. However, if binge drinking occurs on a regular basis (five or more times per month) and is accompanied by the above signs, alcoholism may be a factor. Regardless, treatment is an option to help control excessive drinking, no matter the degree of alcohol abuse.

• Can you die from withdrawal?

  Many withdrawal symptoms are extremely uncomfortable but will not result in death. However, depending on the person and on the degree and longevity of the alcoholism, some withdrawal symptoms can arise that have the potential to be deadly. These symptoms include seizures and DTs. While rare, if the level of alcoholism is severe enough to have resulted in these symptoms, serious health complications, and even death, can occur. As a result, medical detox is always recommended for alcohol withdrawal.

• What is the ‘kindling’ effect?

  Kindling is when a person undergoes repeated episodes of excessive drinking and withdrawal, and each subsequent withdrawal results in worse symptoms. As an example, an individual on the first detox attempt from alcohol may not exhibit severe symptoms at all; however, after several cycles of alcohol abuse and withdrawal, the same person might exhibit seizures or DTs. Kindling also may contribute to an increased likelihood of relapse after each subsequent withdrawal, and may increase damage to brain function.

  For this reason, it is important to maintain recovery for as long as possible. While relapse is often part of alcoholism and recovery, repeated relapse and withdrawal contributes to worsening of the physical and emotional damage alcoholism can cause.

• What are the causes of alcoholism?

  The direct causes of alcoholism are unknown; however, there are numerous contributing factors that either precede or co-occur with alcoholism. These include:

  • Depression, anxiety, or other mental health disorders
  • Childhood trauma
  • Having family members who abuse or are addicted to alcohol
  • Lack of self-esteem
  • Limited or nonexistent social support
  • Peer pressure to drink
  • Regular binge drinking or heavy drinking over a long period of time

  
  The reasons a person becomes addicted are complex and varied. Because of this, treatment for alcoholism is most likely to result in long-term recovery when the treatment program is personalized based on the individual’s specific issues and needs.

• Is alcoholism hereditary?

  Genetics certainly affect alcoholism. A person is more likely to develop a problem with alcohol if family members also have problems with alcohol. Nevertheless, a genetic predisposition does not mean the person will develop an alcohol use disorder. Likewise, not having the predisposition does not mean a person won’t develop a problem with alcohol. Alcoholism develops from a complex combination of factors that must all be taken into consideration when treating an individual.

  Ultimately, as with any disease or disorder, even if there is a genetic component, alcoholism can be managed with treatment that is customized for the individual, including the understanding of the person’s family history regarding alcohol abuse.

• Does AA work?

  There has been a great deal of debate as to whether treatment programs like Alcoholics Anonymous – on their own – are effective in treating alcohol abuse disorders. Many people credit AA with helping them overcome their alcohol abuse problems.

  While there is not conclusive evidence that AA works on its own, it has been shown to be particularly helpful as part of aftercare following an intensive, inpatient rehab program. On its own, however, it does not necessarily provide the full spectrum of treatment modalities that have been shown to result in the most positive outcomes for alcoholism treatment.

• What are therapy options?

  There are various therapy options for alcoholism treatment. These types of therapy are mostly aimed at helping the person learn to understand what triggers a craving for alcohol and developing or providing strategies and tools to help diffuse those triggers. Types of therapy may include:

  • Cognitive Behavioral Therapy (CBT): This is focused on understanding thought processes and negative responses in order to be able to substitute other more positive behaviors.
  • Trauma-focused CBT: This form of CBT takes into account any personal trauma that may be contributing to the negative thought-behavior cycle.
  • Dialectical Behavior Therapy (DBT): This therapy helps people manage their perceptions of change and their acceptance of their condition; it is especially helpful for those with dual diagnoses.
  • Interpersonal therapy: This therapy helps people build a social support structure that can distract from certain triggers and help overcome triggers that lead to cravings.
  • Family therapy: Working with the individual’s family can help manage enabling, codependence, and other relationship issues that may directly or indirectly exacerbate the alcoholism issue.

• Is there a cure for alcoholism?

  There is no cure for alcoholism. It is a chronic disorder that results when the brain and body become dependent on alcohol. Nevertheless, as with many chronic illnesses, alcoholism can be effectively managed. Continued commitment to recovery, coupled with a research-based, comprehensive treatment program customized to the individual, and including appropriate follow-up care, can help the person who is struggling with alcoholism to reach and maintain recovery for the long term.