Alcoholism – NIH Definition

ALCOHOLISM

Getting the Facts

For many people, the facts about alcoholism are not clear. What is
alcoholism, exactly? How does it differ from alcohol abuse? When should a
person seek help for a problem related to his or her drinking? The
National Institute on Alcohol Abuse and Alcoholism (NIAAA) has prepared
this booklet to help individuals and families answer these and other
common questions about alcohol problems. The information below will
explain alcoholism and alcohol abuse, symptoms of each, when and where to
seek help, treatment choices, and additional helpful resources.

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A Widespread Problem

For most people, 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 (A standard drink is one
12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5
ounces of 80-proof distilled spirits) — is not harmful for most adults.
Nonetheless, a substantial number of people have serious trouble with
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 patterns that could lead to alcohol problems. In
addition, approximately 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). It 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,
recreational accidents, and on-the-job accidents and also increases the
likelihood of homicide and suicide. In purely economic terms, alcohol-use
problems cost society approximately $100 billion per year. In human
terms, the costs are incalculable.

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What Is Alcoholism?

Alcoholism, which is also known as “alcohol dependence syndrome,” is a
disease that is characterized by the following elements:

  • Craving: A strong need, or compulsion, to
    drink.
  • Loss of control: The frequent inability to stop
    drinking once a person has begun.
  • Physical dependence: The occurrence of withdrawal
    symptoms, such as nausea, sweating, shakiness, and anxiety, when
    alcohol use is stopped after a period of heavy drinking. These symptoms
    are usually relieved by drinking alcohol or by taking another sedative
    drug.
  • Tolerance: The need for increasing amounts of
    alcohol in order to get “high.”

Alcoholism has little to do with what kind of alcohol one drinks, how
long one has been drinking, or even exactly how much alcohol one
consumes. But it has a great deal to do with a person’s uncontrollable
need for alcohol. This description of alcoholism helps us understand why
most alcoholics can’t just “use a little willpower” to stop drinking. He
or she is frequently in the grip of a powerful craving for alcohol, a
need that can feel as strong as the need for food or water. While some
people are able to recover without help, the majority of alcoholic
individuals need outside assistance to recover from their disease. With
support and treatment, many individuals are able to stop drinking and
rebuild their lives. Many people wonder: Why can some individuals use
alcohol without problems, while others are utterly unable to control
their drinking? Recent research supported by NIAAA has demonstrated that
for many people, a vulnerability to alcoholism is inherited. Yet it is
important to recognize that aspects of a person’s environment, such as
peer influences and the availability of alcohol, also are significant
influences. Both inherited and environmental influences are called “risk
factors.” But risk is not destiny. Just because alcoholism tends to run
in families doesn’t mean that a child of an alcoholic parent will
automatically develop alcoholism.

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What Is Alcohol Abuse?

Alcohol abuse differs from alcoholism in that it does not include an
extremely strong craving for alcohol, loss of control, or physical
dependence. In addition, alcohol abuse is less likely than alcoholism to
include tolerance (the need for increasing amounts of alcohol to get
“high”). Alcohol abuse is defined as a pattern of drinking that is
accompanied by 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;
  • 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 effects of alcohol.

While alcohol abuse is basically different from alcoholism, it is
important to note that many effects of alcohol abuse are also experienced
by alcoholics.

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What Are the Signs of a
Problem?

How can you tell whether you, or someone close to you, may have a
drinking problem? Answering the following four questions can help you
find out. (To help remember these questions, note that the first letter
of a key word in each of the four questions spells “CAGE.”)

  • 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 (Eye opener)?

One “yes” response suggests a possible alcohol problem. If you
responded “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 responses 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 for
you.

Even if you answered “no” to all of the above questions, if you are
encountering drinking-related problems with your job, relationships,
health, or with the law, you should still seek professional help. The
effects of alcohol abuse can be extremely serious–even fatal–both to
you and to others.

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The Decision To Get Help

Acknowledging that help is needed for an alcohol problem may not be
easy. But keep in mind that the sooner a person gets help, the better are
his or her chances for a successful recovery.

Any reluctance you may feel about discussing your drinking with your
health care professional may stem from common misconceptions about
alcoholism and alcoholic people. In our society, the myth prevails that
an alcohol problem is somehow 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, however, alcoholism is a disease that is no more a
sign of weakness than is asthma or diabetes. 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
experiencing 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 professional concludes that you
may be dependent on alcohol, he or she may recommend that you see a
specalist in diagnosing and treating alcoholism. You should be involved
in making referral decisions and have all treatment choices explained to
you.

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Getting Well

Alcoholism Treatment

The nature of treatment depends on the severity of an individual’s
alcoholism and the resources that are available in his or her community.
Treatment may include detoxification (the process of safely getting
alcohol out of one’s system); taking doctor-prescribed medications, such
as disulfiram (Antabuse®) or naltrexone (ReViaTM), to help
prevent a return to drinking once drinking has stopped; and individual
and/or group counseling. There are promising types of counseling that
teach recovering 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. Any of these treatments may be provided in a
hospital or residential treatment setting or on an outpatient basis.

Because the involvement 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. Some programs also link up
individuals with vital community resources, such as legal assistance, job
training, child care, and parenting classes.

Alcoholics Anonymous

Virtually all alcoholism treatment programs also include meetings of
Alcoholics Anonymous (AA), which describes itself as a “worldwide
fellowship of men and women who help each other to stay sober.” While AA
is generally recognized as an effective mutual help program for
recovering alcoholics, not everyone responds to AA’s style and message,
and other recovery approaches are available. Even those who are helped by
AA usually find that AA works best in combination with other elements of
treatment, including counseling and medical care.

Can Alcoholism Be Cured?

While alcoholism is a treatable disease, a cure is not yet available.
That means that even if an alcoholic has been sober for a long while 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 eventually 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 is needed to abstain from
drinking.

Help for Alcohol Abuse

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:

  • Examine the benefits of stopping an unhealthy drinking
    pattern.
  • Set a drinking goal for yourself. Some people choose to abstain
    from alcohol, while 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.

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New Directions

With the support of NIAAA, scientists at medical centers and
universities throughout the country are studying alcoholism. The goal of
this research is to develop more effective 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 include:

  • Genetic research: Scientists are now studying
    3,000 individuals from several hundred families with a history of
    alcoholism in order to pinpoint the location of genes that influence
    vulnerability to alcoholism. This new knowledge will help identify
    individuals at high risk for alcoholism and also will pave the way for
    the development of new treatments for alcohol-related problems. Other
    research is investigating the ways in which genetic and environmental
    factors combine to cause alcoholism.
  • Treatment approaches: NIAAA also sponsored a study
    called Project MATCH, which tested whether treatment outcome could be
    improved by matching patients to three types of treatment based on
    particular individual characteristics. This study found that all three
    types of treatment reduced drinking markedly in the year following
    treatment.
  • New medications: Studies supported by NIAAA have
    led to the Food and Drug Administration’s approval of the medication
    naltrexone (ReViaTM) for the treatment of alcoholism. When used in
    combination with counseling, this prescription drug lessens the craving
    for alcohol in many people and helps prevent a return to heavy
    drinking. Naltrexone is the first medication approved in 45 years to
    help alcoholics stay sober after they detoxify from alcohol.

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 to prevent alcohol problems; identify alcohol
abuse and alcoholism at earlier stages; and make available new, more
effective treatment approaches for individuals and families.

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Resources

For more information on alcohol abuse and alcoholism, contact the
following organizations:

Al-Anon Family Group Headquarters
1600 Corporate Landing Parkway
Virginia Beach, VA 23454-5617
Internet address: http://www.al-anon.alateen.org

Makes referrals to local Al-Anon groups, which are support groups for
spouses and other significant adults in an alcoholic person’s life. Also
makes referrals to Alateen groups, which offer support to children of
alcoholics.

Locations of Al-Anon or Alateen meetings worldwide can be obtained by
calling the toll-free numbers Monday through Friday, 8 a.m.-6 p.m.
(e.s.t.):

U. S.: (800) 344-2666
Canada: (800) 443-4525

Free informational materials can be obtained by calling the toll-free
numbers (operating 7 days a week, 24 hours per day):

U. S.: (800) 356-9996
Canada: (800) 714-7498

Alcoholics Anonymous (AA) World Services
475 Riverside Drive, 11th Floor
New York, NY 10115
(212) 870-3400
Internet address: http://www.alcoholics-anonymous.org

Makes referrals to local AA groups and provides informational
materials on the AA program. Many cities and towns also have a local AA
office listed in the telephone book.

National Council on Alcoholism and Drug Dependence
(NCADD)

12 West 21st Street
New York, NY 10010
(800) NCA-CALL
Internet address: http://www.ncadd.com

Provides phone numbers of local NCADD affiliates (who can provide
information on local treatment resources) and educational materials on
alcoholism via the above toll-free number.

National Institute on Alcohol Abuse and
Alcoholism

Scientific Communications Branch
6000 Executive Boulevard, Suite 409
Bethesda, MD 20892-7003
(301) 443-3860
Internet address: http://www.niaaa.nih.gov

Makes available free informational materials on all aspects of
alcoholism, including the effects of drinking during pregnancy, alcohol
use and the elderly, and help for cutting down on drinking.

Prepared: November 1996

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