Alcohol use and abuse

Many Americans drink alcohol, which produces a sense of relaxation and euphoria. Moderate drinking, defined by the National Institute on Alcohol Abuse andAlcoholism (NIAAA) as up to two drinks per day for men and one drink per dayfor women and older people (a standard drink is one 12-ounce beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces or 80-proof distilled spirits), does not harm most adults. Still, many people in the United States drink too much. According to NIAAA, 1 in every 13 adults-nearly 14 million Americans-abuse alcoholic or are alcoholics. Several million more adults could be on their way to alcohol problems. Men who have more than 14 drinks a week or fourdrinks at one time and women who have more than seven drinks a week or threedrinks at one time are at risk for alcohol abuse or dependence. More than half of all Americans report that they have one or more close relatives with a drinking problem.

Alcohol abuse (the dangerous use of alcohol without dependence) and alcoholism (a dependence on alcohol) are major social, economic, and public health problems in the United States. Each year, about 100,000 deaths nationwide are wholly or partially attributed to drinking. Alcoholism is the third leading cause of death nationwide; it would be number one if traffic accidents and deathcertificate diagnoses related to alcohol were included in the statistics. Alcoholism reduces the life expectancy of alcoholics by 10 to 12 years. According to NIAAA, each year, alcohol-related problems cost society approximately $100 billion.

Alcohol is one of the most commonly abused substances among teenagers and young adults, even though it is illegal for anyone under the age of 21 to buy ordrink alcohol. Half of all adults who abuse alcohol started drinking too much while they were teenagers. Alcoholism usually develops in early adulthood.People with a family history of alcoholism are more likely than other peopleto become alcoholics themselves. Sons of alcoholic fathers have a one in fourchance of becoming an alcoholic. In the United States, people of Irish and Native descent are at increased risk for alcoholism. Jewish and Asian Americans are at decreased risk. There is no difference in the prevalence of alcoholism between African Americans, whites, and Hispanics. Most alcoholics are men;women who become alcoholics generally do so later in life than men do. Severely depressed or anxious people are at high risk for alcoholism. People who are impulsive, excitable, and seek novelty; and those with attention deficit hyperactivity disorder; are also at higher risk for alcoholism.

Misusing alcohol has serious, and in many cases life-threatening, consequences. People who abuse or are dependent on alcohol are at increased risk for liver disease, heart disease, certain cancers (especially those of the liver, esophagus, throat, and voice box), immune system problems, and brain damage. Pregnant women who drink too much can harm their fetuses. Some alcohol-relatedmedical problems are both reversible and treatable. Drinking also increases the risk of death from car crashes and other accidents. For example, alcohol contributes to 50% of all deaths from motor vehicle accidents. People who drink too much are also more likely than people who do not to commit homicide orsuicide. Abusing alcohol also results in problems with work, school, or homeresponsibilities, including relationships with friends, family, and coworkers.

People who drink too much can be alcohol abusers or alcoholics. There is no clear line between alcohol abuse and alcoholism. Alcohol abuse is the dangerous use of alcohol without dependence. It is a pattern of drinking along with one or more of the following problems within a year:

  • Failure to meet major work, school, or home responsibilities,
  • Drinking in situations which are physically dangerous, such as while driving a car or operating machinery,
  • Legal problems related to alcohol which happen again and again,like being arrested for drinking under the influence of alcohol or hurting someone while drunk, and
  • Continued drinking despite having alcohol-related problems with relationships that are either caused or made worse by theeffects of alcohol.

Alcohol abuse is different than alcoholism, but alcohol abusers can experience many of the same negative effects of alcohol that alcoholics do.

Alcoholism is a chronic disease which is progressive and often fatal. Peoplecan become alcoholics no matter what kind of alcohol they drink, how long they have been drinking, or even how much alcohol they consume. Alcoholism is adependence on alcohol known as "alcohol dependence syndrome." After prolongedexposure to alcohol, the brain adapts to the changes made by alcohol and becomes dependent on it. This dependence is marked by:

  • Craving: A strongneed to drink,
  • Loss of control: The frequent inability to stop drinking,
  • Physical dependence: When drinking is stopped, people experiencewithdrawal symptoms, like nausea, sweating, shakiness, and anxiety. Drinkingor taking a sedative will usually relieve withdrawal symptoms, and
  • Tolerance: Alcoholics need more and more alcohol to get "high."

Alcoholics have an uncontrollable need for alcohol. Their lives revolve around drinking, which dominates the way that they think, feel, and act.

The NIAAA lists four warning signs of drinking problems:

  • Feeling a need to cut down on drinking,
  • Getting annoyed when others criticizing the person's drinking,
  • Feeling bad or guilty about drinking, and
  • Having a drink upon waking up to steady the nerves or get rid of a hangover.

Any one of these signs indicates a drinking problem and the need to get help.People who have not experienced these problems but have had drinking-relatedproblems with work, relationships, health, or the law should also seek help.

Alcoholism is caused primarily by dependence, but there are usually other factors-biology, genetics, culture, and psychology--involved. In addition to causing relaxation and euphoria, alcohol depresses the central nervous system. Despite years of research, experts still do not know exactly how alcohol affects the brain, or how the brain affects alcoholism. Researchers believe that alcohol has major affects on the brain's hippocampus, which is associated withlearning and memory and regulation emotion, sensory processing, appetite, and stress. Alcohol breaks down into fatty acid ethyl esters that appear to inhibit chemical messengers in the brain. Thus, alcohol interferes with messagesto the brain. Alcohol alters the way that drinkers feel, hear, see, and move. It creates difficulty walking, poor balance, slurring of speech, and generally poor coordination. Misusing alcohol has serious, and in many cases life-threatening, consequences. The earlier the person begins drinking heavily, thehigher his/her risk of developing serious illnesses later on. People who abuse or are dependent on alcohol are at increased risk for liver disease, heartdisease, certain cancers (especially those of the liver, esophagus, throat,and voice box), immune system problems, and brain damage. Pregnant women whodrink too much can harm their fetuses. At higher alcohol levels, breathing and heart rates become slower, and people may vomit. An overdose of alcohol mayresult in coma and death. Drinking also increases the risk of death from carcrashes and other accidents. For example, alcohol contributes to 50% of alldeaths from motor vehicle accidents. People who drink too much are also morelikely than people who do not to commit homicide or suicide. Abusing alcoholalso results in problems with work, school, or home responsibilities, including relationships with friends, family, and coworkers. Some problems with alcohol, such as interactions with medications, interpersonal problems, and birthdefects, can occur after drinking over a relatively short period of time. Others, such as liver disease, heart disease, certain cancers, and pancreatitis, are due to long-term alcohol abuse and develop gradually. Long-term alcoholuse affects virtually every organ system. People who drink too much can be alcohol abusers or alcoholics.

Alcohol also interacts negatively with more than 150 medications. Alcohol makes some medicines stronger and others weaker. For example, alcohol increasesthe drowsiness caused by antihistamines for a cold or allergy, and increasesthe risk of serious liver damage for people who take a lot of the painkilleracetaminophen. People who take over-the-counter or prescription medications should check with their doctors before drinking any amount of alcohol.

The more people drink, the more likely it is that they will have alcohol-related interpersonal problems with their relationships with family, friends, co-workers, and even strangers. These problems include: arguments, continued absence from or lateness to work, losing jobs due to decreased productivity, orcommitting or being victims of violence.

Pregnant women who drink can cause many birth defects in their babies. Fetalalcohol syndrome, which can cause physical abnormalities, mental impairment,and behavior problems, is the most serious alcohol-related birth defect. Fetal alcohol syndrome and other alcohol-related birth defects can cause lifelonglearning and behavior problems. Drinking during pregnancy can also lead to low birth weight babies and an increased risk for miscarriage. Doctors do notknow exactly how much alcohol is takes to cause these birth defects and otherproblems, so pregnant women are advised not to drink any alcohol at all.

Alcohol can cause liver and other gastrointestinal tract problems. More than2 million Americans have liver disease related to alcohol. Some develop alcoholic hepatitis, an inflammation of the liver. Symptoms of this are fever; yellowing of the skin, eyeballs, and urine; and abdominal pain. Alcoholic hepatitis can be fatal if the person continues to drink, but is often reversible ifthe person quits. About 10 to 20 percent of heavy drinkers develop alcoholicscarring of the liver called cirrhosis. This can also cause death if drinking continues. It is not reversible like alcoholic hepatitis, but if the personstops drinking, chances of survival increase dramatically. Alcohol can irritate the stomach's lining, causing gastritis, vomiting, and bleeding. Stomachinflammation can also result in bleeding and pain, and decreased appetite. Diarrhea is common, due to alcohol's effect on the pancreas, which helps regulate blood sugar levels by producing insulin and helps people digest food. Inflammation of the pancreas, called pancreatitis, (pancreatitis), is a painful condition which causes severe abdominal pain, leads to weight loss, and can befatal.

Moderate drinking can be good for the heart, but drinking too much over a long period of time increases the risk for high blood pressure, heart disease, and some kinds of strokestroke. Heart disease is the leading cause of death among alcoholics. With excessive alcohol, blood pressure becomes dangerously high. Drinking too much can also destroy the heart muscle through cardiomyopathy, a heart disease with symptoms ranging from irregular heartbeats to heart failure.

People who drink too much may also be at increased risk for certain forms ofcancer, especially cancer of the esophagus, mouth, throat, and voice box. Cancer is the second leading cause of death among alcoholics. Women who drink two or more drinks a day are at a slightly increased risk of developing breastcancer. Drinking too much may also increase the risk for developing cancer ofthe colon and rectum.

Alcohol has many negative effects on the brain. People who are abuse or are dependent on alcohol often black out, have trouble sleeping, and can get a neurological disorder called Wernicke-Korsakoff's syndrome. During black outs, they forget all of part of what happened while they were drinking. They may have problems with short-term memory. They may feel exhausted in the morning, even after getting enough sleep because alcohol interferes with the brain's ability to produce enough dreaming periods of sleep. Wernicke-Korsakoff's syndrome occurs in alcoholics who do not have enough nutrients, especially thiamine. This is really two separate disorders that often occur together in alcoholics. Wernicke's syndrome causes weakness and paralysis of the eye muscles, and may cause double vision. As time goes on, it can cause problems standing orwalking. Korsakoff's syndrome severely affects memory (amnesia), especiallyloss of recent memory. Alcoholics with Wernicke-Korsakoff's syndrome may sometimes forget who they are, become disoriented, and have hallucinations. Wernicke-Korsakoff's syndrome can result in permanent brain damage and even death.

Alcohol suppresses the immune system, which normally fights off infection. Asa result of this, alcoholics are more likely than other people to get infections, such as serious pneumonia.

The ability to drive can become impaired with little alcohol. For example, ablood alcohol concentration (BAC) as low as 0.02 percent can impair people'sability to steer a car while responding to changes in traffic. A 160-pound man will have a BAC of twice that (0.04 percent) an hour after drinking two beers on an empty stomach. The more alcohol consumed, the more driving skills are impaired.

Heavy drinking can also cause sexual and reproductive problems. It can causemen to become impotent and women to have menstrual irregularities.

Most alcoholics deny that they have drinking problems. They get treatment reluctantly, usually because of pressure from their families, employers, or friends, or as a result of health or legal problems. When family members or friends confront the alcoholic and urge him/her to get help, his/her chances of recovery increase. Diagnosis often occurs when family members alert an alcoholic abuser or alcoholic's physician to the problem. The doctor may suspect alcoholism if a patient suffers repeated injuries or experiences medical problemsrelated to alcohol use. The doctor will do a physical examination, and ask many questions about alcohol use, including how much the person drinks, and how drinking affects relationships, jobs, educational goals, and family life. The doctor may recommend a specialist in diagnosing and treating alcoholism. The type of treatment depends on how severe the alcoholism is and the type ofresources that are available in the person's community.

There is no cure for alcoholism but it can be treated. Some alcoholics recover on their own, but most need outside help. Treatment programs usually include detoxification (the process of safely getting alcohol out of the person's system), counseling, and sometimes medications that help prevent a return to drinking. The most common residential treatment is the "Minnesota Model," which includes abstinence, individual and group therapy, participation in Alcoholics Anonymous, work assignments, activity therapy, and use of recovery lay counselors and professional staff; this model is now used nationwide. Other treatments which have not been as well evaluated include acupuncture, electoencephalography, biofeedback, and aversion therapy.

In a program based on the Minnesota Model, the first step is admitting the addiction to alcohol. Treatment may begin with detoxification, in a special detoxification unit with medical care and careful monitoring. The withdrawal process usually last 3 to 7 days, but it can last for weeks. Common withdrawal symptoms include: hand tremors; increases in pulse, blood pressure, and body temperature; nausea; diarrhea; and difficulty sleeping. More dangerous withdrawal symptoms occur if the alcoholic experiences delirium tremens (DTs). Thesesymptoms include delirium, confusion, aggression, vivid hallucinations, severe tremors, paranoia, and seizures. They require medical treatment and oftenlast at least 3 to 5 days. Patients at highest risk for DTs often have othermedical problems too. Medical problems associated with alcoholism will also be treated. Abstinence from drinking is required.

After detoxification, the next treatment phase is recovery. Recovery includeseducation about the disease, the damage alcohol does to the body, and the problems it causes. Most programs have classes every day, group therapy, individual counseling, recreation therapy, and an introduction to the principles ofAlcoholics Anonymous during the recovery phase. Alcoholics Anonymous (AA) isa self-help group that describes itself as a "worldwide fellowship of men and women who help each other stay sober." AA uses a 12-step model to help people stay sober. These steps involve recognizing the destructive power that alcohol has held over the alcoholic's life, looking to a higher power for help,and reflecting on the ways in which the use of alcohol has hurt others and, if possible, making amends. Recovering alcoholics listen and share their stories, so alcoholics learn that they are not alone.

Medications may be used to help people who have trouble abstaining from alcohol or to decrease cravings. Disulfiram (Antabuse) deters alcoholics from drinking by causing nausea and vomiting, abdominal pain, flushing, and headacheswhen the person drinks. Naltrexone (ReVia) may decrease cravings for alcoholby blocking its intoxicating effects. However, medications alone are not helpful; alcoholics must work very hard to achieve recovery.

Recovering alcoholics need continued support after treatment, including fromtheir family. Participation in support systems like AA and Al-Anon is recommended. Al-Anon is a self-help group for family members of recovering alcoholics.

Alcoholics who stay sober are always susceptible to relapse and can never drink alcohol. Successful recovery requires the person to stop drinking completely; cutting down does not work. It is common for recovered alcoholics to relapse. When this happens, the person needs to stop drinking again and get any support necessary to keep from starting again. Relapsing does not mean that they have failed or cannot eventually achieve long-term sobriety.

Doctors can also help prevent people who abuse alcohol but are not alcoholicsfrom becoming alcoholics. Depending on the situation, they can help alcoholabusers cut down or stop drinking. This is done through screening and brief interventions. After screening for alcohol abuse, a treatment plan of brief interventions is put together, usually by alcohol abuse specialists. Brief interventions can include feedback, contracting and goal setting, behavior modification, written materials such as self-help manuals, counseling, and follow up care.

Research about alcohol use and its consequences is ongoing. NIAAA supports about 90 percent of all of this research in the United States. The goal of NIAAA supported alcohol research is to provide practical information to help people who suffer due to alcohol abuse and alcoholism. Alcohol researchers are currently working on discovering: who is at risk for alcohol-related problems;how alcohol affects the body, including the brain; how the risk for alcoholism is inherited; what the health benefits and risks of moderate drinking are;and what therapies, including medications, show promise for treating alcoholdependence more effectively.

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