Scope of the problem
What Is Alcoholism?
What Is Alcohol Abuse?
What Are the Signs of a Problem?
The Decision To Get Help
Can Alcoholism Be Cured
Help for Alcohol Abuse
For most people who drink, alcohol is a pleasant accompaniment
to social activities. Moderate alcohol use-up to two drinks per
day for men and one drink per day for women and older people-is
not harmful for most adults. (A standard drink is one 12-ounce bottle
or can of either beer or wine cooler, one 5-ounce glass of wine,
or 1.5 ounces of 80-proof distilled spirits.) Nonetheless, a large
number of people get into serious trouble because of their drinking.
Currently, nearly 14 million Americans-1 in every 13 adults-abuse
alcohol or are alcoholic. Several million more adults engage in
risky drinking that could lead to alcohol problems. These patterns
include binge drinking and heavy drinking on a regular basis. In
addition, 53 percent of men and women in the United States report
that one or more of their close relatives have a drinking problem.
The consequences of alcohol misuse are serious-in many cases, life
threatening. Heavy drinking can increase the risk for certain cancers,
especially those of the liver, esophagus, throat, and larynx (voice
box). Heavy drinking can also cause liver cirrhosis, immune system
problems, brain damage, and harm to the fetus during pregnancy.
In addition, drinking increases the risk of death from automobile
crashes as well as recreational and on-the-job injuries. Furthermore,
both homicides and suicides are more likely to be committed by persons
who have been drinking. In purely economic terms, alcohol-related
problems cost society approximately $185 billion per year. In human
terms, the costs cannot be calculated.
Alcoholism, also known as "alcohol dependence," is a
disease that includes four symptoms:
- Craving: A strong need, or compulsion, to drink.
- Loss of control: The inability to limit one's
drinking on any given occasion.
- Physical dependence: Withdrawal symptoms,
such as nausea, sweating, shakiness, and anxiety, occur when alcohol
use is stopped after a period of heavy drinking.
- Tolerance: The need to drink greater amounts
of alcohol in order to "get high."
People who are not alcoholic sometimes do not understand why an
alcoholic can't just "use a little willpower" to stop
drinking. However, alcoholism has little to do with willpower. Alcoholics
are in the grip of a powerful "craving," or uncontrollable
need, for alcohol that overrides their ability to stop drinking.
This need can be as strong as the need for food or water. Although
some people are able to recover from alcoholism without help, the
majority of alcoholics need assistance. With treatment and support,
many individuals are able to stop drinking and rebuild their lives.
Many people wonder why some individuals can use alcohol without
problems but others cannot. One important reason has to do with
genetics. Scientists have found that having an alcoholic family
member makes it more likely that if you choose to drink you too
may develop alcoholism. Genes, however, are not the whole story.
In fact, scientists now believe that certain factors in a person's
environment influence whether a person with a genetic risk for alcoholism
ever develops the disease. A person's risk for developing alcoholism
can increase based on the person's environment, including where
and how he or she lives; family, friends, and culture; peer pressure;
and even how easy it is to get alcohol.
Alcohol abuse differs from alcoholism in that it does not include
an extremely strong craving for alcohol, loss of control over drinking,
or physical dependence. Alcohol abuse is defined as a pattern of
drinking that results in one or more of the following situations
within a 12-month period:
- Failure to fulfill major work, school, or home responsibilities;
- Drinking in situations that are physically dangerous, such as
while driving a car or operating machinery;
- Having recurring alcohol-related legal problems, such as being
arrested for driving under the influence of alcohol or for physically
hurting someone while drunk;
- Continued drinking despite having ongoing relationship problems
that are caused or worsened by the drinking.
Although alcohol abuse is basically different from alcoholism,
many effects of alcohol abuse are also experienced by alcoholics.
How can you tell whether you may have a drinking problem? Answering
the following four questions can help you find out:
- 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 (as an
"eye opener") to steady your nerves or get rid of a
One "yes" answer suggests a possible alcohol problem.
If you answered "yes" to more than one question, it is
highly likely that a problem exists. In either case, it is important
that you see your doctor or other health care provider right away
to discuss your answers to these questions. He or she can help you
determine whether you have a drinking problem and, if so, recommend
the best course of action.
Even if you answered "no" to all of the above questions,
if you encounter drinking-related problems with your job, relationships,
health, or the law, you should seek professional help. The effects
of alcohol abuse can be extremely serious-even fatal-both to you
and to others.
Accepting the fact that help is needed for an alcohol problem may
not be easy. But keep in mind that the sooner you get help, the
better are your chances for a successful recovery.
Any concerns you may have about discussing drinking-related problems
with your health care provider may stem from common misconceptions
about alcoholism and alcoholic people. In our society, the myth
prevails that an alcohol problem is a sign of moral weakness. As
a result, you may feel that to seek help is to admit some type of
shameful defect in yourself. In fact, alcoholism is a disease that
is no more a sign of weakness than is asthma. Moreover, taking steps
to identify a possible drinking problem has an enormous payoff-a
chance for a healthier, more rewarding life.
When you visit your health care provider, he or she will ask you
a number of questions about your alcohol use to determine whether
you are having problems related to your drinking. Try to answer
these questions as fully and honestly as you can. You also will
be given a physical examination. If your health care provider concludes
that you may be dependent on alcohol, he or she may recommend that
you see a specialist in treating alcoholism. You should be involved
in any referral decisions and have all treatment choices explained
The type of treatment you receive depends on the severity of your
alcoholism and the resources that are available in your community.
Treatment may include detoxification (the process of safely getting
alcohol out of your system); taking doctor-prescribed medications,
such as disulfiram (Antabuse®) or naltrexone (ReVia?), to help
prevent a return (or relapse) to drinking once drinking has stopped;
and individual and/or group counseling. There are promising types
of counseling that teach alcoholics to identify situations and feelings
that trigger the urge to drink and to find new ways to cope that
do not include alcohol use. These treatments are often provided
on an outpatient basis.
Because the support of family members is important to the recovery
process, many programs also offer brief marital counseling and family
therapy as part of the treatment process. Programs may also link
individuals with vital community resources, such as legal assistance,
job training, childcare, and parenting classes.
Virtually all alcoholism treatment programs also include Alcoholics
Anonymous (AA) meetings. AA describes itself as a "worldwide
fellowship of men and women who help each other to stay sober."
Although AA is generally recognized as an effective mutual help
program for recovering alcoholics, not everyone responds to AA's
style or message, and other recovery approaches are available. Even
people who are helped by AA usually find that AA works best in combination
with other forms of treatment, including counseling and medical
Although alcoholism can be treated, a cure is not yet available.
In other words, even if an alcoholic has been sober for a long time
and has regained health, he or she remains susceptible to relapse
and must continue to avoid all alcoholic beverages. "Cutting
down" on drinking doesn't work; cutting out alcohol is necessary
for a successful recovery.
However, even individuals who are determined to stay sober may
suffer one or several "slips," or relapses, before achieving
long-term sobriety. Relapses are very common and do not mean that
a person has failed or cannot recover from alcoholism. Keep in mind,
too, that every day that a recovering alcoholic has stayed sober
prior to a relapse is extremely valuable time, both to the individual
and to his or her family. If a relapse occurs, it is very important
to try to stop drinking once again and to get whatever additional
support you need to abstain from drinking.
If your health care provider determines that you are not alcohol
dependent but are nonetheless involved in a pattern of alcohol abuse,
he or she can help you to:
- Examine the benefits of stopping an unhealthy drinking pattern.
- Set a drinking goal for yourself. Some people choose to abstain
from alcohol. Others prefer to limit the amount they drink.
- Examine the situations that trigger your unhealthy drinking
patterns, and develop new ways of handling those situations so
that you can maintain your drinking goal. Some individuals who
have stopped drinking after experiencing alcohol-related problems
choose to attend AA meetings for information and support, even
though they have not been diagnosed as alcoholic.
With NIAAA's support, scientists at medical centers and universities
throughout the country are studying alcoholism. The goal of this
research is to develop better ways of treating and preventing alcohol
problems. Today, NIAAA funds approximately 90 percent of all alcoholism
research in the United States. Some of the more exciting investigations
focus on the causes, consequences, treatment, and prevention of
Genetics: Alcoholism is a complex disease.
Therefore, there are likely to be many genes involved in increasing
a person's risk for alcoholism. Scientists are searching for these
genes, and have found areas on chromosomes where they are probably
located. Powerful new techniques may permit researchers to identify
and measure the specific contribution of each gene to the complex
behaviors associated with heavy drinking. This research will provide
the basis for new medications to treat alcohol-related problems.
Treatment: NIAAA-supported researchers
have made considerable progress in evaluating commonly used therapies
and in developing new types of therapies to treat alcohol-related
problems. One large-scale study sponsored by NIAAA found that
each of three commonly used behavioral treatments for alcohol
abuse and alcoholism-motivation enhancement therapy, cognitive-behavioral
therapy, and 12-step facilitation therapy-significantly reduced
drinking in the year following treatment. This study also found
that approximately one-third of the study participants who were
followed up either were still abstinent or were drinking without
serious problems 3 years after the study ended. Other therapies
that have been evaluated and found effective in reducing alcohol
problems include brief intervention for alcohol abusers (individuals
who are not dependent on alcohol) and behavioral marital therapy
for married alcohol-dependent individuals.
Medications development: NIAAA has
made developing medications to treat alcoholism a high priority.
We believe that a range of new medications will be developed based
on the results of genetic and neuroscience research. In fact,
neuroscience research has already led to studies of one medication-naltrexone
(ReVia?)-as an anticraving medication. NIAAA-supported researchers
found that this drug, in combination with behavioral therapy,
was effective in treating alcoholism. Naltrexone, which targets
the brain's reward circuits, is the first medication approved
to help maintain sobriety after detoxification from alcohol since
the approval of disulfiram (Antabuse®) in 1949. The use of
acamprosate, an anticraving medication that is widely used in
Europe, is based on neuroscience research. Researchers believe
that acamprosate works on different brain circuits to ease the
physical discomfort that occurs when an alcoholic stops drinking.
Acamprosate should be approved for use in the United States in
the near future, and other medications are being studied as well.
Combined medications/behavioral therapies:
NIAAA-supported researchers have found that available medications
work best with behavioral therapy. Thus, NIAAA has initiated a
large-scale clinical trial to determine which of the currently
available medications and which behavioral therapies work best
together. Naltrexone and acamprosate will each be tested separately
with different behavioral therapies. These medications will also
be used together to determine if there is some interaction between
the two that makes the combination more effective than the use
of either one alone.
In addition to these efforts, NIAAA is sponsoring promising research
in other vital areas, such as fetal alcohol syndrome, alcohol's
effects on the brain and other organs, aspects of drinkers' environments
that may contribute to alcohol abuse and alcoholism, strategies
to reduce alcohol-related problems, and new treatment techniques.
Together, these investigations will help prevent alcohol problems;
identify alcohol abuse and alcoholism at earlier stages; and make
available new, more effective treatment approaches for individuals