Alcohol Abuse
Basics
Alcohol dependence (alcoholism) is a condition in which a person becomes physically dependent on alcohol Table 01. Physical or psychological repercussions from drinking, rather than the amount of alcohol consumed or frequency with which a person drinks, define alcohol abuse and dependence. With increased consumption, a person can develop a tolerance to alcohol, and will require greater quantities of alcohol to achieve a "high" feeling. A person with alcohol dependence may also experience symptoms of withdrawal with reduced alcohol intake.
Alcohol abuse is the most common psychiatric disease in the US, with an estimated 13.7% to 23.5% of the general population experiencing problems with abuse or dependence during their lifetimes Table 02. Most people who have alcohol problems are employed and have families. Only 5% are stereotypical "Skid Row" drinkers. More men than women are affected by alcohol abuse, however the prevalence in women is rising. Professionals and executives, people under the age of 25, and elderly people are also at risk for alcohol abuse.
Table 1. Continuum of Alcohol Abuse Severity
| Classification | Behavior |
|---|---|
| Social drinker | Amount consumed and setting appear socially acceptable, but person has a propensity to overindulge or occasionally use alcohol to cope with stress |
| Heavy social drinker | Drinks in socially acceptable settings, but actively seeks occasions to drink, usually more than 2 drinks per day |
| Problem drinker | Heavy drinker, gets drunk, exhibits medical, legal, social, psychological consequences of excessive alcohol consumption; may have made attempts to cut down; variably functional |
| Alcohol-dependent | Tries to consume same excessive amount of alcohol regardless of mood or setting; alcohol is given top priority in all situations; tolerance develops and symptoms of withdrawal may be noted during the workday when alcohol levels drop; individual is aware of his compulsion, but is difficult to reach |
| Severely deteriorated | Constant state of intoxication; the person doesn't care for self or surroundings; many hospitalizations for detoxification and medical care after alcohol-related trauma or organ damage occur |
Table 2. Racial and Gender Difference In Alcohol Abuse and Related Problems
| Race or gender | Comments |
|---|---|
| White | Largest number with alcohol problems |
| Double the rate of driving under the influence of alcohol | |
| White women have higher rates of alcohol abuse and dependence than women of other races | |
| Black | Higher rates of abstinence and lower rates of heavy use (especially in women) |
| Higher rates of alcohol-related disease, injury, psychological problems, and homicide | |
| Greater alcohol-related problems among the socioeconomically deprived | |
| Hispanic | Great diversity in drinking patterns among different groups |
| Lower rates of use among women | |
| Heavier use and greater alcohol-related problems after age 30 | |
| American Indian and Native Alaskan | Great diversity in drinking patterns among tribal groups |
| Highest prevalence of AA-D among all racial groups | |
| Highest consumption between ages 25 and 45 (75% of traumatic deaths and suicides are related to alcohol) | |
| Asian | Lowest levels of alcohol consumption, alcohol abuse and dependence, and related problems |
| Female | Few studies prior to 1980; lower rates of heavy drinking and alcohol-related problems than men; heavier drinking among younger age groups (21-35 years), those living with heavy-drinking partner or spouse, those unmarried living with significant others, and those who are unemployed or employed part-time. Increased rates of drinking as gender roles approximate those in men. Heavy drinking tends to develop following medical or psychiatric illness |
Alcohol depresses the central nervous system, altering thinking, judgment, and behavior. People with alcohol problems crave a drink, and are not able to limit their intake. With increased consumption, the alcoholic loses his or her ability to think clearly and maintain normal coordination.
Alcohol abuse is thought to occur when drinking repeatedly interferes with school, work, household responsibilities, and relationships with family and friends. Some people with alcohol problems are arrested for drinking and driving, or for displaying intoxicated behavior.
Alcohol abuse can seriously endanger physical health Table 03. Liver, pancreas, and brain damage can occur with alcohol abuse, as can gastrointestinal inflammation, ulceration, and diarrhea. Chronic alcohol abuse is associated with an increased incidence of pneumonia and tuberculosis, and alcoholics are 10 times more likely to have cancer. Sleep, memory, and sexual performance disturbances can occur in alcoholics as well.
Alcohol abuse and dependence create a number of social and psychological problems: it is associated with the spread of sexually transmitted diseases, as well as increased rates of domestic abuse, violent crime, and suicide Table 04.
Table 3. Medical Illness Associated With Chronic Alcohol Abuse
| Disorder | Illness |
|---|---|
| Metabolic | Alcoholic ketoacidosis, alcoholic hypoglycemia, water and salt disorders |
| Neurologic | Chronic problems with thinking such as Wernicke's encephalopathy and Korsakoff's psychosis, alcoholic cerebellar degeneration, and central pontine myelinolysis leading to problems walking and other motor activities, acute and chronic dementia, alcoholic peripheral neuropathy |
| Muscular | Acute and chronic alcoholic muscle weakness |
| Gastrointestinal | Fatty liver, alcoholic hepatitis, alcoholic cirrhosis, alcoholic pancreatitis, poor pancreatic function, gastroesophageal reflux, esophageal carcinoma, erosive gastritis, chronic diarrhea, malabsorption, esophageal varices leading to bleeding into the GI tract |
| Metabolic-endocrine | High cholesterol, high levels of uric acid, low testosterone levels, impotence, testicular atrophy, gynecomastia, irregular menstrual periods, reversible Cushing's syndrome |
| Blood | Anemia due to poor production of blood cells or slow intestinal bleeding, poor white cell production, destruction of platelets, blood too thin to clot properly. |
| Cardiac | Decreased cardiac function, arrhythmias, dilated cardiomyopathy, high blood pressure |
| Pulmonary | Increased incidence of pneumonia, increased incidence of tuberculosis |
| Other | Increased incidence of severe intestinal infections, fetal alcohol syndrome, vitamin deficiency syndromes, trauma, sexual dysfunction, insomnia |
Table 4. Social Problems Associated With Alcohol Abuse and Dependence in the United States
| Accidental death and injury | 50% of fatal car crashes |
| 25-fold increased risk of falls or drowning | |
| 50% of fire-related burns or deaths | |
| 20% to 30% of trauma seen in emergency rooms | |
| Crime | Frequently involved in violent crime |
| Suicide | Involved in up to 35% of suicides |
| Economic cost | $148 billion annually (estimated); 15% for health care and treatment |
| Other | Associated with increased rates of spouse or child abuse and increased spread of sexually transmitted diseases |
Causes
Genetic, environmental, and sociocultural factors are all thought to contribute to alcohol abuse and dependence. The cause for alcohol abuse is not completely understood; biological, societal, psychological, and behavioral theories have been proposed as possible reasons. Studies of twins and of adopted children reveal that there is some genetic link to alcoholism. However, children also learn about and establish attitudes towards drinking by observing parents and peers, suggesting that social factors also play a role.
Some studies indicate that people who abuse alcohol do not become intoxicated as easily as non-abusers. Some research shows that the brains of alcohol abusers tend to be less sensitive to the effects of the alcohol than non-abusers' brains. Therefore, alcohol abusers need to drink more than the average person in order to become intoxicated, which may lead to the physical problems of dependence.
Symptoms
If you experience difficulties such as arguments, repeated missed deadlines or appointments, absenteeism, driving after drinking, and run-ins with the law after drinking, you may have an alcohol problem Table 05.
Table 5. Indicators of Possible Problem Drinking
| Acute symptoms | Chronic symptoms | Other signs |
|---|---|---|
| - Recurrent intoxication- Amnesic episodes (blackouts)- Nausea- Sweating- Tachycardia- Tremor- Fatigue- Grand mal seizures- Hallucinations- Delirium tremens | - Mood swings- Depression- Anxiety- Insomnia- Dyspepsia- Nausea- Diarrhea- Bloating- Hematemesis- Jaundice- Unsteady gait- Paraesthesia- Memory loss- Erectile dysfunction | - Heavy, regular alcohol consumption- Other substance abuse, either illegal or prescription- Heavy cigarette smoking- Poor nutrition- Inability to articulate feelings- Multiple psychosomatic problems- Spontaneous abortion- Child with fetal alcohol syndrome- Domestic violence and abuse- Frequent falls or minor trauma (especially in the elderly)- Absenteeism from work- Interpersonal, financial, and legal problems- Accidents, burns, violence; suicide attempts- Unexpected response to medication |
An inability to stop drinking, having symptoms of withdrawal, and compulsive consumption indicate alcohol dependence. An arrest for drinking and driving, being sent home from work for smelling like alcohol, or physically or verbally abusing your family after a few drinks serve as strong warnings that you may have an alcohol problem.
Risk Factors
Having an alcoholic parent increases your risk of developing alcohol problems.
Close relatives of people who are dependent on alcohol are three to four times more likely than the general population to develop alcohol problems themselves. While the disease tends to run in families, not every child of an alcoholic parent will develop alcohol-related problems. In addition, people with no family history can become dependent upon alcohol as well.
Growing up in a troubled household may increase your risk of becoming an alcoholic, as may feelings of isolation, depression, and anger. Many alcoholics watched parents fight and separate. Some have low self-esteem, or suffer from bouts of depression and anxiety that may be temporarily alleviated by the "high" feeling one gets from alcohol.
Gender, age, and race influence your risk for alcoholism. Men, younger people, and whites experience more alcohol-related problems than women, older people, or other racial groups, respectively.
While men have more problems with alcohol than women, substance-related physical ailments sometimes progress more quickly in women than they would in men because of differences in body composition and alcohol metabolism.
Elderly patients sometimes start drinking to manage stress, induce sleep, or deal with the loss of a loved one.
Young people under the age of 25 are at risk of developing alcohol problems in high school or college.
Professionals and executives who drink socially during the day are at an increased risk of developing alcohol dependence or abuse.
Diagnosis
Alcohol dependence (alcoholism) is a condition in which a person becomes physically dependent on alcohol Table 01. Physical or psychological repercussions from drinking, rather than the amount of alcohol consumed or frequency with which a person drinks, define alcohol abuse and dependence. With increased consumption, a person can develop a tolerance to alcohol, and will require greater quantities of alcohol to achieve a "high" feeling. A person with alcohol dependence may also experience symptoms of withdrawal with reduced alcohol intake.
Alcohol abuse is the most common psychiatric disease in the US, with an estimated 13.7% to 23.5% of the general population experiencing problems with abuse or dependence during their lifetimes Table 02. Most people who have alcohol problems are employed and have families. Only 5% are stereotypical "Skid Row" drinkers. More men than women are affected by alcohol abuse, however the prevalence in women is rising. Professionals and executives, people under the age of 25, and elderly people are also at risk for alcohol abuse.
Table 1. Continuum of Alcohol Abuse Severity
| Classification | Behavior |
|---|---|
| Social drinker | Amount consumed and setting appear socially acceptable, but person has a propensity to overindulge or occasionally use alcohol to cope with stress |
| Heavy social drinker | Drinks in socially acceptable settings, but actively seeks occasions to drink, usually more than 2 drinks per day |
| Problem drinker | Heavy drinker, gets drunk, exhibits medical, legal, social, psychological consequences of excessive alcohol consumption; may have made attempts to cut down; variably functional |
| Alcohol-dependent | Tries to consume same excessive amount of alcohol regardless of mood or setting; alcohol is given top priority in all situations; tolerance develops and symptoms of withdrawal may be noted during the workday when alcohol levels drop; individual is aware of his compulsion, but is difficult to reach |
| Severely deteriorated | Constant state of intoxication; the person doesn't care for self or surroundings; many hospitalizations for detoxification and medical care after alcohol-related trauma or organ damage occur |
Table 2. Racial and Gender Difference In Alcohol Abuse and Related Problems
| Race or gender | Comments |
|---|---|
| White | Largest number with alcohol problems |
| Double the rate of driving under the influence of alcohol | |
| White women have higher rates of alcohol abuse and dependence than women of other races | |
| Black | Higher rates of abstinence and lower rates of heavy use (especially in women) |
| Higher rates of alcohol-related disease, injury, psychological problems, and homicide | |
| Greater alcohol-related problems among the socioeconomically deprived | |
| Hispanic | Great diversity in drinking patterns among different groups |
| Lower rates of use among women | |
| Heavier use and greater alcohol-related problems after age 30 | |
| American Indian and Native Alaskan | Great diversity in drinking patterns among tribal groups |
| Highest prevalence of AA-D among all racial groups | |
| Highest consumption between ages 25 and 45 (75% of traumatic deaths and suicides are related to alcohol) | |
| Asian | Lowest levels of alcohol consumption, alcohol abuse and dependence, and related problems |
| Female | Few studies prior to 1980; lower rates of heavy drinking and alcohol-related problems than men; heavier drinking among younger age groups (21-35 years), those living with heavy-drinking partner or spouse, those unmarried living with significant others, and those who are unemployed or employed part-time. Increased rates of drinking as gender roles approximate those in men. Heavy drinking tends to develop following medical or psychiatric illness |
Alcohol depresses the central nervous system, altering thinking, judgment, and behavior. People with alcohol problems crave a drink, and are not able to limit their intake. With increased consumption, the alcoholic loses his or her ability to think clearly and maintain normal coordination.
Alcohol abuse is thought to occur when drinking repeatedly interferes with school, work, household responsibilities, and relationships with family and friends. Some people with alcohol problems are arrested for drinking and driving, or for displaying intoxicated behavior.
Alcohol abuse can seriously endanger physical health Table 03. Liver, pancreas, and brain damage can occur with alcohol abuse, as can gastrointestinal inflammation, ulceration, and diarrhea. Chronic alcohol abuse is associated with an increased incidence of pneumonia and tuberculosis, and alcoholics are 10 times more likely to have cancer. Sleep, memory, and sexual performance disturbances can occur in alcoholics as well.
Alcohol abuse and dependence create a number of social and psychological problems: it is associated with the spread of sexually transmitted diseases, as well as increased rates of domestic abuse, violent crime, and suicide Table 04.
Table 3. Medical Illness Associated With Chronic Alcohol Abuse
| Disorder | Illness |
|---|---|
| Metabolic | Alcoholic ketoacidosis, alcoholic hypoglycemia, water and salt disorders |
| Neurologic | Chronic problems with thinking such as Wernicke's encephalopathy and Korsakoff's psychosis, alcoholic cerebellar degeneration, and central pontine myelinolysis leading to problems walking and other motor activities, acute and chronic dementia, alcoholic peripheral neuropathy |
| Muscular | Acute and chronic alcoholic muscle weakness |
| Gastrointestinal | Fatty liver, alcoholic hepatitis, alcoholic cirrhosis, alcoholic pancreatitis, poor pancreatic function, gastroesophageal reflux, esophageal carcinoma, erosive gastritis, chronic diarrhea, malabsorption, esophageal varices leading to bleeding into the GI tract |
| Metabolic-endocrine | High cholesterol, high levels of uric acid, low testosterone levels, impotence, testicular atrophy, gynecomastia, irregular menstrual periods, reversible Cushing's syndrome |
| Blood | Anemia due to poor production of blood cells or slow intestinal bleeding, poor white cell production, destruction of platelets, blood too thin to clot properly. |
| Cardiac | Decreased cardiac function, arrhythmias, dilated cardiomyopathy, high blood pressure |
| Pulmonary | Increased incidence of pneumonia, increased incidence of tuberculosis |
| Other | Increased incidence of severe intestinal infections, fetal alcohol syndrome, vitamin deficiency syndromes, trauma, sexual dysfunction, insomnia |
Table 4. Social Problems Associated With Alcohol Abuse and Dependence in the United States
| Accidental death and injury | 50% of fatal car crashes |
| 25-fold increased risk of falls or drowning | |
| 50% of fire-related burns or deaths | |
| 20% to 30% of trauma seen in emergency rooms | |
| Crime | Frequently involved in violent crime |
| Suicide | Involved in up to 35% of suicides |
| Economic cost | $148 billion annually (estimated); 15% for health care and treatment |
| Other | Associated with increased rates of spouse or child abuse and increased spread of sexually transmitted diseases |
Genetic, environmental, and sociocultural factors are all thought to contribute to alcohol abuse and dependence. The cause for alcohol abuse is not completely understood; biological, societal, psychological, and behavioral theories have been proposed as possible reasons. Studies of twins and of adopted children reveal that there is some genetic link to alcoholism. However, children also learn about and establish attitudes towards drinking by observing parents and peers, suggesting that social factors also play a role.
Some studies indicate that people who abuse alcohol do not become intoxicated as easily as non-abusers. Some research shows that the brains of alcohol abusers tend to be less sensitive to the effects of the alcohol than non-abusers' brains. Therefore, alcohol abusers need to drink more than the average person in order to become intoxicated, which may lead to the physical problems of dependence.
If you experience difficulties such as arguments, repeated missed deadlines or appointments, absenteeism, driving after drinking, and run-ins with the law after drinking, you may have an alcohol problem Table 05.
Table 5. Indicators of Possible Problem Drinking
| Acute symptoms | Chronic symptoms | Other signs |
|---|---|---|
| Recurrent intoxicationAmnesic episodes (blackouts)NauseaSweatingTachycardiaTremorFatigueGrand mal seizuresHallucinationsDelirium tremens | Mood swingsDepressionAnxietyInsomniaDyspepsiaNauseaDiarrheaBloatingHematemesisJaundiceUnsteady gaitParaesthesiaMemory lossErectile dysfunction | Heavy, regular alcohol consumptionOther substance abuse, either illegal or prescriptionHeavy cigarette smokingPoor nutritionInability to articulate feelingsMultiple psychosomatic problemsSpontaneous abortionChild with fetal alcohol syndromeDomestic violence and abuseFrequent falls or minor trauma (especially in the elderly)Absenteeism from workInterpersonal, financial, and legal problemsAccidents, burns, violence; suicide attemptsUnexpected response to medication |
An inability to stop drinking, having symptoms of withdrawal, and compulsive consumption indicate alcohol dependence. An arrest for drinking and driving, being sent home from work for smelling like alcohol, or physically or verbally abusing your family after a few drinks serve as strong warnings that you may have an alcohol problem.
Having an alcoholic parent increases your risk of developing alcohol problems.
Close relatives of people who are dependent on alcohol are three to four times more likely than the general population to develop alcohol problems themselves. While the disease tends to run in families, not every child of an alcoholic parent will develop alcohol-related problems. In addition, people with no family history can become dependent upon alcohol as well.
Growing up in a troubled household may increase your risk of becoming an alcoholic, as may feelings of isolation, depression, and anger. Many alcoholics watched parents fight and separate. Some have low self-esteem, or suffer from bouts of depression and anxiety that may be temporarily alleviated by the "high" feeling one gets from alcohol.
Gender, age, and race influence your risk for alcoholism. Men, younger people, and whites experience more alcohol-related problems than women, older people, or other racial groups, respectively.
While men have more problems with alcohol than women, substance-related physical ailments sometimes progress more quickly in women than they would in men because of differences in body composition and alcohol metabolism.
Elderly patients sometimes start drinking to manage stress, induce sleep, or deal with the loss of a loved one.
Young people under the age of 25 are at risk of developing alcohol problems in high school or college.
Professionals and executives who drink socially during the day are at an increased risk of developing alcohol dependence or abuse.
Your doctor will ask questions about possible job, school, or family difficulties that you may have that are related to alcohol. He or she will also look for biological markers that indicate heavy alcohol use, and will ask about how much alcohol you normally consume Table 06. When taking a medical history, your doctor will ask about any disruptions in your social or work life that may have stemmed from alcohol problems.
Blood tests indicating elevated liver enzymes or changes to blood cells signal heavy alcohol intake. Acute increase in acetate and ethanol levels in the blood may indicate acute intoxication. Alcohol can be measured in the blood for up to 24 hours. Changes in albumin levels in the blood also can suggest an alcohol problem, as can a nutritional deficiency.
Table 6. Safety of Various Drinking Levels
| - | Men | Women |
|---|---|---|
| Safe levels | Up to 2 drinks per day | Up to 1 drink per day |
| At-risk levels | More than 14 drinks per week or more than 4 drinks per occasion | More than 7 drinks per week or more than three drinks per occasion |
| Heavy drinking | More then 5 or 6 drinks a day | More than three or four drinks per day |
A series of questions called the CAGE screening tool can help determine if you have a problem with alcohol Table 07. The questions of the CAGE screening tool ask about your desire to cut back on alcohol consumption, annoyance at other peoples' opinions about your drinking habits, guilty feelings about alcohol intake, and whether or not you've ever started the day with an alcoholic beverage to combat a hangover, or to steady your nerves. A "yes" to any of the questions suggests increased risk. Two or more positive responses indicate a need to seek assistance.
Table 7. CAGEa Screening Exam
| A positive answer to any of these questions signals an increased risk for alcohol problems |
|---|
| Have you ever felt you should cut down on your drinking? |
| Have people annoyed you by criticizing your drinking? |
| Have you ever felt bad or guilty about your drinking? |
| Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover? |
aCAGE: Cut down, annoyed by criticism, guilty about drinking, eye-opener drinks.
This test is not recommended for the elderly.
The Michigan Alcoholism Screening Test (MAST) is another self-test that can help you determine if you have a drinking problem Table 08.
Table 8. Michigan Alcoholism Screening Test (MAST)
| Question | Yes or No | Points |
|---|---|---|
| Do you enjoy a drink now and then? | - | 1 for Yes |
| Do you feel you are a normal drinker (drink less or as much as others)? | - | 2 for No |
| Have you ever awakened in the morning after some drinking the night before and found that you could not remember a part of the evening? | - | 2 for Yes |
| Does your wife, husband, a parent, or other near relative ever worry or complain about your drinking? | - | 1 for Yes |
| Can you stop drinking without a struggle after one or two drinks? | - | 2 for No |
| Do you ever feel guilty about your drinking? | - | 1 for Yes |
| Do friends or relatives think you are a normal drinker? | - | 2 for No |
| Are you able to stop drinking when you want to? | - | 2 for No |
| Have you ever attended a meeting of Alcoholics Anonymous (AA)? | - | 5 for Yes |
| Have you ever gotten into physical fights when drinking? | - | 1 for Yes |
| Has your drinking ever created problems between you and your wife, husband, a parent, or other relative? | - | 2 for Yes |
| Has your wife or husband (or other family members) ever gone to anyone for help about your drinking? | - | 2 for Yes |
| Have you ever lost friends because of drinking? | - | 2 for Yes |
| Have you gotten into trouble at work or school because of drinking? | - | 2 for Yes |
| Have you ever lost a job because of drinking? | - | 2 for Yes |
| Have you ever neglected your obligations, your family, or your work for two or more days in a row because of drinking? | - | 2 for Yes |
| Do you drink before noon fairly often? | - | 1 for Yes |
| Have you ever been told you have liver trouble? Cirrhosis? | - | 2 for Yes |
| After heavy drinking, have you ever had delirium tremens (DTs) or severe shaking, or heard voices or seen things that weren't really there? | - | 2 for Yes (5 for DTs) |
| Have you ever gone to anyone for help about your drinking? | - | 5 for Yes |
| Have you ever been in a hospital because of drinking? | - | 2 for Yes |
| Have you ever been a patient in a psychiatric hospital or on a psychiatric ward of a general hospital where drinking was a part of the problem that resulted in hospitalization? | - | 2 for Yes |
| Have you ever been at a psychiatric or mental health clinic or gone to any doctor, social worker, or clergyman for help with any emotional problems, where drinking was part of the problem? | - | 2 for Yes |
| Have you ever been arrested for drunk driving, driving while intoxicated, or driving under the influence of alcoholic beverages? (If "yes," how many times?) | - | 2 for each arrest |
| Have you ever been arrested or taken into custody for a few hours because of other drunken behavior? | - | 2 for each arrest |
| Total points | - | - |
Scoring: 3 points or less, nonalcoholic; 4 points, suggestive of alcoholism; 5 points, alcoholic category.
Avoid habitual alcohol consumption, and establish and maintain friendships with people who do not drink. When stressed or facing a challenging situation, talk to a friend rather than turning to the bottle.
Join a support group to help yourself work through challenging temptations to drink. Alcoholics Anonymous (AA) has helped countless individuals stay sober.
Al-Anon is a support group intended to help spouses deal with the challenges of living with an alcoholic. Children of alcoholics can also join a support group, such as Al-Ateen.
Prevention and Screening
Avoid habitual alcohol consumption, and establish and maintain friendships with people who do not drink. When stressed or facing a challenging situation, talk to a friend rather than turning to the bottle.
Join a support group to help yourself work through challenging temptations to drink. Alcoholics Anonymous (AA) has helped countless individuals stay sober.
Al-Anon is a support group intended to help spouses deal with the challenges of living with an alcoholic. Children of alcoholics can also join a support group, such as Al-Ateen.
Treatment
Alcohol withdrawal sometimes requires urgent medical attention. Regular, heavy drinkers can experience symptoms of withdrawal within 6 to 48 hours of their last drink. Symptoms include tremors, weakness, nausea, sweating, seizures, hallucinations, anxiety, an increased pulse, and elevated blood pressure. If the person does not receive treatment, life-threatening delirium tremens can develop 2 to 10 days after the patient stops drinking. Symptoms of delirium tremens include anxiety, hallucinations, confusion, inability to sleep, nightmares, depression, fever, and agitation. Symptoms of withdrawal often develop after patients are hospitalized for other conditions. Without intervention, withdrawal symptoms prompt many patients to return to the bottle.
Doctors typically order medications, vitamins, and fluids to manage withdrawal symptoms. Withdrawal symptoms can be unpleasant and, in the case of delirium tremens, life-threatening. Tranquilizing drugs such as benzodiazepines help to keep the patient calm. Beta blockers and calcium channel blockers may be added to the treatment plan to control elevations in blood pressure and heart rate. Vitamins help combat nutritional deficiencies common in people who drink excessively. Fluids replace liquid lost due to alcohol's diuretic effects. Only about one-quarter of alcohol-dependent patients require drugs to treat withdrawal.
Some patients require hospitalization for complications of alcohol abuse. Many alcoholics have medical, psychiatric, and social problems that are severe enough to require hospitalization. Some of the more serious complications include heart failure, pancreatitis, gastrointestinal bleeding, and hepatitis. In addition, some alcoholics require hospitalization because they can no longer care for themselves.
At the first signs of alcohol-related difficulty, seek support or treatment to stop drinking. Changing habits to stay sober presents an extreme challenge to alcoholics, and many relapse within weeks. Treatment programs improve the odds of long-term sobriety. About 20% of alcohol-dependent patients kick the habit without medical or psychological treatment.
Monitor your drinking habits by keeping a log. Try to detect causes for and consequences of your drinking patterns. Doing so will help you learn alternate ways of coping with the people, places, situations, and feelings associated with heavy drinking.
Do not use alcohol to treat insomnia or emotional problems.
Insomnia is normal after alcohol withdrawal, and will improve over subsequent weeks. Try relaxation techniques, meditation, exercise, and hobbies to modify your behavior and decrease anxiety so you can sleep better.
Establish realistic goals for yourself and don't push beyond your limits.
Abide by a set bedtime and wake-up schedule, and avoid caffeine and napping.
Encourage your family to seek counseling or self-help groups like Al-Anon or Al-A-Teen.
Your doctor is the best source of information on the drug treatment choices available to you.
If an alcohol problem is caught early (before dependence occurs), treatment may consist of education, abstinence recommendations, and reassurance. Doctors often are the first to recognize an alcohol problem. By calling symptoms to the patient's attention while informing the person of the potential physical, social, and emotional dangers of excessive drinking, alcohol abuse can often be stopped early.
Inpatient and outpatient substance abuse treatment programs are available to help alcohol abusers quit drinking Table 09. Inpatient and outpatient substance abuse treatment programs typically include alcoholics anonymous (AA) group sessions. Alcoholics anonymous is a free self-help group where people help each other stay away from alcohol. Formal treatment programs, inpatient or outpatient, cost money and involve professionals who intervene to help the alcohol abuser give up drinking, improve coping skills, make lifestyle changes that promote abstinence, and address underlying psychological issues. Alcohol abusers must want to stay sober before any treatment will work. As a legal drug, alcohol is easy to obtain, and temptation is always present. Developing routines and making friends with people who do not drink increases the chances for participants' success.
Table 9. Psychosocial Therapy Options for Alcohol Abuse
| Alcoholics Anonymous (AA) | Free therapy program that uses a supportive approach to follow 12 steps to work through during recovery. Particularly effective in economically disadvantaged, isolated, or lonely patients or for individuals from a heavy-drinking social background. |
| 12-Step Facilitation Program | Formal approach incorporating AA and other 12-step programs. |
| Cognitive Behavioral Therapy (CBT) | Aims to teach the patient by role-play or rehearsal to recognize and cope with high-risk situations for relapse, and to recognize and cope with craving. |
| Motivational and Enhancement Therapy (MET) | Based on motivating patients to use their own resources to change their behavior. Found to be the most effective approach in patients with high levels of anger. |
Programs advocating moderation exist, but abstinence remains the most accepted treatment option. Experts consider moderate drinking to be two or fewer drinks per day for men, and one drink per day at most for women and older adults. Patients often cut back, but slip up and are not successful at limiting their intake, leading to more problems. Therefore, abstinence has become the recommended approach to treatment.
A growing fetus can be damaged if the pregnant mother consumes alcohol. Babies born to mothers who drink may suffer from mental retardation, hyperactivity, and behavioral problems. Some will be born with improperly formed organs. The amount of alcohol needed to cause damage is not known. Expecting mothers, or women who are trying to become pregnant, should abstain from drinking alcohol.
Older adults who drink increase their risk for falls and other accidents, and may experience a worsening of existing medical conditions. People's bodies process alcohol differently as they age. The brain becomes more susceptible to alcohol's depressant effects, and the amount of alcohol needed to produce a "high" feeling decreases. Alcohol can increase blood pressure, and may aggravate ulcers and other ailments.
Before dependence occurs, patients face a favorable prognosis. Physical or psychological dependence decreases your odds of achieving sobriety. Early diagnosis and intervention raises the rate of success by 50% to 90%.
It is difficult for many patients to overcome alcoholism. Most people tend to fall back into old, comfortable alcohol habits unless they receive adequate treatment and support. Alcoholics Anonymous provides that assistance to millions of people. Studies have shown that more than 60% of middle-class alcoholics remain sober for at least one year after completing treatment.
Your chances of remaining sober increase the longer you avoid alcohol. The majority of alcoholics relapse within one year. Some develop an alternating pattern of drinking and sobriety. The longer a person stays sober, however, the greater the odds that he or she will remain free of alcohol.
Alcoholics who continue drinking do not live as long as those who stop. Continuing to drink can shorten an alcoholic's life by an average of 15 years. Heart disease claims most alcoholics, followed by cancer, accidents, and suicide.
Recovering alcoholics must make a lifelong commitment to maintain sobriety. You should continue to be in contact with treatment professionals for six months to one year after all you quit drinking. Monthly follow-up is very effective for reinforcing abstinence and avoiding future problems. Your treatment sessions should address the challenges involved in living without alcohol, filling your time with nondrinking activities, forming friendships with people who do not drink, and managing stress.