ALCOHOLISM

DEFINITION

Alcoholism is the popular term for two disorders: alcohol abuse and alcohol dependence. The key element of these disorders is that a person's use of alcohol has repeatedly caused problems in his or her life. Alcoholism has serious consequences on a person's health and personal life, on family and friends, and on society at large.

DESCRIPTION

The effects of alcoholism on the body are quite far-reaching. Alcohol abuse can result in poor nutrition, memory disorders, difficulty with walking and balance, liver disease, high blood pressure, muscle weakness, heart problems, anemia (a blood disorder that causes weakness and fatigue; see anemias entry), problems with blood clotting, low resistance to infections, disorders of the digestive system, problems with the pancreas, low blood sugar, high blood fat content, reduced sexual abilities, reproductive problems, and weak bones.

Alcoholism can also lead to a number of personal problems, including depression, unemployment, family problems, and child abuse. The effects of alcoholism also extend to society at large. For example, alcohol is a contributing factor in about half of all deaths from motor vehicle accidents. The condition also causes or contributes to other social issues, such as homelessness, murder, suicide, injury, and violent crime. According to some estimates, more than $130 billion are spent each year in the United States to deal with alcohol-related problems.

CAUSES

Most scientists believe that alcoholism is caused by a number of factors including the physical make-up of a person, the environment in which they grew up, and other social and psychological reasons. One of the most important of these factors is heredity. Studies have shown that children who are born to alcoholic parents are four times more likely to become alcoholics than children who are not from alcoholic backgrounds. This trend holds true even when the children are raised away from their biological parents. Current research is being developed to identify other factors that contribute to alcoholism.

SYMPTOMS

The symptoms of alcoholism can be broken down into two major categories: symptoms of acute (immediate) alcohol use and symptoms of chronic (long-term) alcohol use.

Acute Effects of Alcohol Use

Any amount of alcohol that a person consumes goes quickly to the brain. There it exerts a numbing effect. An individual may experience mild mood swings, or have trouble walking or maintaining balance. He or she may not be able to speak clearly and may lose coordination. The loss of coordination accounts for the high rate of accidents involving alcoholism.

As the level of alcohol in a person's blood increases, physical problems become more serious. Heart and respiration (breathing) rates slow down. At high enough alcohol levels, a person may fall into a coma and even die.

Chronic Effects of Alcohol Use

Long-term use of alcohol can affect virtually every organ system of the body:

• Blood. Alcohol can cause changes in all kinds of blood cells. It can reduce the production of white blood cells, for example, which weakens a person's immune system. This means that an individual loses the ability to fight off disease and infection. Blood platelets (pronounced PLATE-lit; blood cells that help blood clot) can also be damaged, increasing the risk of bleeding.
• Gastrointestinal system. Alcohol exerts its effects on nearly every part of the digestive system. It can damage muscles in the stomach lining, allowing stomach acid to flow upwards and back into the esophagus (pronounced ee-SAH-fuh-guss). This action causes pain and bleeding in the esophagus, which is the tubal passage through which food moves from the throat to the stomach.
• Heart. High levels of alcohol in the blood can cause a number of problems in the heart and circulatory system. Heart size tends to increase, heart muscles become weaker, and abnormal heart rhythms begin to appear. All of these changes increase the risk of stroke (the blocking of a brain blood vessel by means of a blood clot; see stroke entry).
• Liver. Alcohol interferes with a number of important chemical reactions that take place in the liver. In order to combat this problem, the liver begins to enlarge and fill in with fat and scar tissue. These materials interfere with the liver's normal function and result in the diseases cirrhosis (pronounced suh-RO-suss) and hepatitis (pronounced hep-uh-TIE-tuss; see hepatitis entry). Both conditions can be fatal.
• Nervous system. Heavy drinking can cause blackouts and loss of memory. By some estimates 30 to 40 percent of all men in their teens and twenties have experienced an alcoholic blackout. Over time, alcohol abuse can also cause sleep disturbances and numbness and tingling in the arms and legs. Two major diseases of the nervous system are associated with alcohol abuse: Wernicke's syndrome and Korsakoff's syndrome. Both are caused by low thiamine (pronouonced THIE-uh-min), or B-vitamin, levels produced by excessive consumption of alcohol.
• Reproductive system. Heavy drinking has a tendency to reduce the size of both testicles and ovaries, the reproductive organs in men and women, respectively. As a result, there is a reduction in the number of sperm and eggs produced, which makes becoming pregnant more difficult.

A magnified image of liver cirrhosis, a disease caused by drinking too much alcohol. (© Prof.

P. Motta/Dept of Anatomy/University of "La Sapienza," Rome/Science Photo Library, National Audubon Society Collection

. Reproduced by permission of

Photo Researchers, Inc.

)

Alcohol can also cause a condition called pancreatitis (pronounced PANG-kree-uh-TIE-tis), which is an inflammation of the pancreas. Damage to the pancreas, in turn, can result in bouts of diarrhea, diabetes (see diabetes entry), and other serious and painful conditions. If left untreated, a person may eventually lose their ability to produce the enzymes the body needs to digest food and may even die.

Babies born to women who consumed alcohol during their pregnancy may develop a condition known as fetal alcohol syndrome. This disorder may cause facial defects, reduced intelligence, and long-term behavioral problems in the child.

DIAGNOSIS

A number of factors may lead a doctor to suspect that an individual is an alcoholic. First, a person may seem to be accident-prone because they repeatedly report unexplained accidents and injuries. In some cases, an alcoholic's family may intervene and alert a physician. In other instances, an individual may realize the need for medical attention. The problem rests not so much with the amount of alcohol a person consumes, but with how alcohol consumption affects the person's well-being, job, educational goals, relationships, and family life.

One technique used by some doctors is called the CAGE questionnaire. It consists of four questions about the patient's drinking patterns:

• Have you ever tried to C ut down on your drinking?
• Have you ever been A nnoyed by anyone's comments about your drinking?
• Have you ever felt G uilty about your drinking?
• Do you ever need an E ye-opener (a morning drink of alcohol) to start the day?

Based on personal interviews and family history, a doctor may diagnose one of two forms of alcoholism: alcohol dependence or alcohol abuse. In the case of alcohol dependence, a person literally seems to depend on alcohol consumption to get through a day. Some characteristics of alcohol dependence include the following:

• Increasing tolerance for alcohol, meaning that a person has become accustomed to consuming a certain amount of alcohol each day and must gradually increase that amount over time.
• Inability of a person to stop drinking without experiencing unpleasant physical and psychological effects.
• A tendency to over drink, meaning that a person consistently drinks more alcohol than he or she really intended or is unable to stop once he or she begins.
• Inappropriate drinking patterns, which include setting aside large blocks of time to drink, drinking instead of performing expected tasks such as attending school or work, or continuing to drink even when the person realizes that his or her job, education, or relationships are being affected.

Alcohol abuse leads to physical, medical, legal, or other kinds of problems as a result of alcohol consumption. A person who abuses alcohol may experience:

• Physical endangerment, such as driving while drunk
• Legal difficulties
• Problems in personal relationships or at work

Physical Signs of Alcoholism

Some surface signs of excessive alcohol consumption include broken capillaries (small blood vessels) on the face, a raspy voice, trembling hands, and chronic diarrhea. Upon further physical examination, a doctor may uncover some additional physical signs of alcoholism. Such signs include a visible network of enlarged veins just under the skin around the navel, fluid in the abdomen, a yellowish tone to the skin, decreased size of the testicles, and poor nutritional health. Laboratory studies may reveal an increase in the size of red blood cells, a reduced number of white blood cells, and an increase in the number of certain liver enzymes.

TREATMENT

Treatment of alcoholism takes place in two steps: detoxification and rehabilitation. Detoxification involves helping a person to stop drinking and ridding his or her body of the harmful (toxic) effects of alcohol.

Detoxification and Withdrawal

Detoxification is often difficult because a person's body becomes accustomed to the intake of alcohol. When alcohol is no longer available, the body goes through a period known as withdrawal. The ease and success of withdrawal depends on the person's prior drinking habits. The amount of alcohol consumed on a regular basis and the length of time the person has been drinking determines the difficulty of the withdrawal process.

Mild withdrawal symptoms may include nausea, achiness, diarrhea, difficulty in sleeping, excessive sweating, trembling, and anxiety. These symptoms often disappear in less than a week. Patients going through a mild withdrawal usually require no medical attention other than observation to see that their symptoms do not become worse.

An individual who has been dependent on alcohol for a long period of time may experience more serious withdrawal symptoms. Such symptoms include fever, increased heart rate, high blood pressure, seizures, and hallucinations, which may take the form of delirium tremens (DT). A person suffering from DT has uncontrollable shaking, panic attacks (see panic disorders entry), and severe hallucinations. DT usually begin about three to five days after the patient's last drink and may last up to a week. During this time, the patient must be monitored.

Patients going through serious withdrawal generally require medical attention. For example, they are often given sedatives to avoid the potentially life-threatening consequences of high blood pressure, rapid heart rate, and seizures.

Rehabilitation

Rehabilitation may involve the use of both medications and recovery programs. Some chemicals act as a deterrent to drinking because when they interact with alcohol they produce nausea, vomiting, and other unpleasant physical effects. One drug that has been used with some positive results is disulfiram (pronounced di-SUL-fuh-ram; trade name Antabuse). Drugs by themselves are often not very effective, however, since they do not deal with some of the reasons that may have contributed to a person becoming an alcoholic.

Recovery programs help alcoholics to understand why they abuse alcohol and to find ways to avoid drinking in the future. Some of the most effective rehabilitation programs involve peer groups in which recovering alcoholics meet regularly and provide support for each other. Perhaps the best known of these groups is Alcoholics Anonymous (AA). The AA recovery program is based on a 12-step model. These steps include the need to recognize the destructive power that alcohol has over an alcoholic's life, the damage that alcoholism has done to others involved personally or professionally with the alcoholic, and the need to turn to a higher power for help in overcoming the problem.

Alternative Treatment

The lives of alcoholics and those around them are quite stressful. Whether stress leads to alcoholism or is a direct result of alcoholism is up for debate. In either case, stress-relieving therapies may help a person avoid alcohol consumption. These therapies include massage, meditation, and hydrotherapy (water therapy).

The harmful physical effects of alcoholism can also be treated by alternative therapies. Vitamins and mineral supplements, for example, can be used to treat malnutrition. The herb known as milk thistle is thought to protect the liver. Other herbs, such as lavender, skullcap, chamomile, peppermint, and yarrow, are believed by some to help an alcoholic through withdrawal. Acupuncture (a Chinese therapy technique where fine needles puncture the body) has also been recommended to decrease withdrawal symptoms and to prevent a return to drinking.

PROGNOSIS

Recovery from alcoholism is a life-long process. In fact, people who have suffered from alcoholism are encouraged to refer to themselves as recovering alcoholics, rather than recovered alcoholics. Probably because alcoholism is believed to be an inherited condition, the risk of returning to an alcoholic lifestyle never completely disappears.

The prognosis for many alcoholics is fairly good. Studies of alcoholics who have the support of family and friends, who are otherwise healthy, and who are motivated, indicate that 60 percent give up drinking for at least one year and, in many cases, for a lifetime.

PREVENTION

Prevention must begin at an early age. In the vast majority of cases, alcoholics begin drinking during their teenage years. Educational programs need to be aimed especially at those known to be at risk—those whose parents or other relatives are alcoholics. Efforts to develop effective prevention programs of this kind continue to be an issue within the United States's educational system.

FOR MORE INFORMATION

Books

Holmes, Pamela. Alcohol. Austin, TX: Steck Vaughn Library Division, 1991.

Pringle, Laurence. Drinking: A Risky Business. New York: William Morrow & Company, 1997.

Organizations

Al-Anon Family Groups, PO Box 182, Madison Square Station, New York, NY 10159. http://www.al-anon-alateen.org.

American Council on Alcoholism. 2522 Saint Paul Street, Baltimore, MD 21218. (410) 889–0100. http://www.aca-usa.org.

National Alliance on Alcoholism and Drug Dependence, Inc. 12 West 12th Street, New York, NY 10010. (212) 206–6779.

Web sites

Alcoholism—Home Page. [Online] http://www.alcoholism.about.com (accessed on June 15, 1999).

Alcoholism.Net. [Online] http://www.alcoholism.net (accessed on June 15, 1999).