Alcohol abuse refers to excessive or problematic alcohol consumption. The behavior continues even when faced with alcohol-related job, legal, social, health, or family problems. Alcohol abuse can progress to alcoholism. Alcoholism is a disease characterized by chronic alcohol abuse that results in a physical dependence on alcohol (withdrawal symptoms occur if alcohol consumption is abruptly stopped) and an inability to stop or limit drinking (“loss of control”).
Family members who abuse alcohol (especially men whose fathers or brothers are alcoholic)
Starting to use alcohol at an early age (younger than 14)
Using illicit drugs or non-medical use of prescription drugs
Peer pressure
Easy access to alcoholic beverages
Psychiatric disorders, such as depression or
anxiety
Smoking
Symptoms
Denial that an alcohol problem exists is common. Alcohol abuse can occur without physical dependence.
Alcohol abuse symptoms include:
Repeated work, school, or home problems due to drinking
Risking physical safety
Recurring trouble with the law, often including drinking and driving
Continuing to drink despite alcohol-related difficulties
Alcohol abuse often progresses to alcohol dependence (alcoholism). Symptoms of alcohol dependence include:
Craving a drink
Unable to stop or limit drinking
Needing greater amounts of alcohol to feel the same effect
Giving up activities in order to drink or recover from alcohol's effects
Drinking that continues even when it causes or worsens health problems
Wanting to stop or reduce drinking, but not being able
Withdrawal symptoms if alcohol is stopped include:
Nausea
Sweating
Shaking
Anxiety
Increased blood pressure
Seizures (delirium tremens, “DTs”)
The brain, nervous system, heart, liver, stomach, gastrointestinal tract, and pancreas can all be damaged by alcoholism.
Diagnosis
Doctors ask a series of questions to assess possible alcohol-related problems, including:
Have you tried to reduce your drinking?
Have you felt bad about drinking?
Have you been annoyed by another person's criticism of your drinking?
Do you drink in the morning to steady your nerves or cure a hangover?
Do you have problems with a job, your family, or the law?
Do you drive under the influence of alcohol?
Tests may include:
Blood tests to look at the size of your red blood cells and to check for a substance called carbohydrate-deficient transferrin.
Blood tests to check for alcohol-related liver disease and other health problems.
Treatment
The first step in treatment is getting the patient to accept that he or she has a problem. A group intervention brings together important people in an individual's life. They confront him or her about how alcohol is affecting all of his or her relationships and functioning.
Treatment for alcohol abuse or dependence is aimed at teaching patients how to manage the disease. Most professionals who treat people with alcohol problems believe that this means giving up alcohol completely and permanently.
The first and most important step is recognizing a problem exists. Successful treatment depends on your desire to change. Your doctor can help you withdraw from alcohol safely. This could require hospitalization in a detoxification center, so that you are carefully monitored for side effects. You may need medication while you are undergoing detoxification.
Treatments include:
Medications
Drugs can help alleviate symptoms of withdrawal and help prevent relapse. The doctor may prescribe medication to reduce cravings for alcohol.
Medications used to treat alcoholism and to try to prevent drinking include:
Naltrexone
(ReVia)—blocks the high that makes you crave alcohol
Disulfiram
(Antabuse)—makes you very sick if you drink alcohol
Acamprosate
(Campral)—reduces your craving for alcohol
A recent study showed that an anticonvulsant drug, topiramate (Topamax), may reduce alcohol dependence.
*
Education and Counseling
Therapy helps you recognize alcohol's dangers. It raises awareness of underlying issues and lifestyles that promote drinking. In therapy, you work to improve coping skills and develop other ways of dealing with stress or pain. You learn new methods of handling situations where alcohol is served.
Mentoring and Community Help
Alcoholics Anonymous (AA) helps many people to stop drinking and stay sober. Members meet regularly and talk about their troubles with alcohol. They support each other. If you feel like drinking, you can call your AA sponsor for help. Your family members may also benefit from attending meetings of Al-Anon. Living with an alcoholic can be a painful, stressful situation.
Here are some general statistics on treatment outcomes of individuals one year after attempting to stop drinking:
1/3 remained abstinent
1/3 resumed drinking but at a lower level
1/3 relapsed completely
Prevention
Realizing that alcohol causes problems helps some people avoid it. Suggestions to decrease the risk of alcohol abuse and dependence include*:
Socialize without alcohol.
Avoid going to bars.
Do not keep alcohol in your home.
Avoid situations and people that encourage drinking.
Make new nondrinking friends.
Do fun things that do not involve alcohol.
Avoid reaching for a drink when stressed or upset.
Limit your alcohol intake to a moderate level
.
Moderate is two or fewer drinks per day for men and one or fewer for women and older adults
A 12-ounce bottle of beer, a five-ounce glass of wine, or 1.5 ounces of liquor is considered one drink.
* Most professionals who treat alcohol abuse and dependence believe that complete abstinence is the only effective “prevention.”
The National Council on Alcoholism and Drug Dependence
http://www.ncadd.org
CANADIAN RESOURCES:
Adult Children Anonymous
http://acainnerpeace.ncf.ca/
Alcoholics Anonymous
http://www.aacanada.com/
References:
American Psychiatric Association.
Diagnostic and Statistical Manual of Mental Disorders.
4th ed. Text Revision. Washington, DC: American Psychiatric Association, 2000.
JAMA patient page: Benefits and dangers of alcohol.
JAMA
. 1999;281(No.1).
JAMA patient page:
Do you have a drinking problem?
JAMA
. 1999;281(No.14).
Griffith's 5-Minute Clinical Consult
. Lippincott Williams and Wilkins; 2006.
National epidemiologic survey on alcohol and related conditions. Alcohol Alert (No. 70). Oct 2006. National Institute on Alcohol Abuse and Alcoholism website. Available at:
http://pubs.niaaa.nih.gov/publications/AA70/AA70.htm
. Accessed February 19, 2007.
National Institute on Alcohol Abuse and Alcoholism website. Available at:
http://www.niaaa.nih.gov/
.
Primary Care Medicine.
4th ed. Lippincott Williams and Wilkins; 2000.
10/25/2007 DynaMed's Systematic Literature Surveillance
DynaMed's Systematic Literature Surveillance
: Johnson BA, Rosenthal N, Capece JA, et al. Topiramate for treating alcohol dependence: a randomized controlled trial.
JAMA.
2007;298:1641-1651.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
