Q and A on Alcoholism and Dependence

FAQ’s on Alcohol Abuse and Alcoholism

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Q #1: What do we mean by alcoholism?

Alcoholism, also known as “alcohol dependence,” is a disease that
includes alcohol craving and continued drinking despite repeated
alcohol-related problems, such as losing a job or getting into trouble
with the law. It includes four symptoms:

  • Craving–A strong need, or compulsion, to drink.
  • Impaired control–The inability to limit one’s drinking on any
    given occasion.
  • Physical dependence–Withdrawal symptoms, such as nausea,
    sweating, shakiness, and anxiety, when alcohol use is stopped after a
    period of heavy drinking.
  • Tolerance–The need for increasing amounts of alcohol in order to
    feel its effects.

For clinical and research purposes, formal diagnostic criteria for
alcoholism also have been developed. Such criteria are included in the
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,
published by the American Psychiatric Association, as well as in the
International Classification Diseases, published by the World Health
Organization.

Q #2: Is alcoholism a disease?

Yes. Alcoholism is a chronic, often progressive disease with
symptoms that include a strong need to drink despite negative
consequences, such as serious job or health problems. Like many other
diseases, it has a generally predictable course, has recognized
symptoms, and is influenced by both genetic and environmental factors
that are being increasingly well defined.

Q #3: Is alcoholism inherited?

Alcoholism tends to run in families, and genetic factors partially
explain this pattern. Currently, researchers are on the way to finding
the genes that influence vulnerability to alcoholism. A person’s
environment, such as the influence of friends, stress levels, and the
ease of obtaining alcohol, also may influence drinking and the
development of alcoholism. Still other factors, such as social support,
may help to protect even high-risk people from alcohol problems.

Risk, however, is not destiny. A child of an alcoholic parent will
not automatically develop alcoholism. A person with no family history
of alcoholism can become alcohol dependent.

Q #4: Can alcoholism be cured?

Not yet. Alcoholism is a treatable disease, and medication has also
become available to help prevent relapse, but a cure has not yet been
found. This means that even if an alcoholic has been sober for a long
time and has regained health, she may relapse and must continue to
avoid all alcoholic beverages.

Q #5: Are there any medications for alcoholism?

Yes. Two different types of medications are commonly used to treat
alcoholism. The first are tranquilizers called benzodiazepines (e.g.,
Valium®, Librium®), which are used only during
the first few days of treatment to help patients safely withdraw from
alcohol.

A second type of medication is used to help people remain sober. A
recently approved medicine for this purpose is naltrexone (ReVia TM).
When used together with counseling, this medication lessens the craving
for alcohol in many people and helps prevent a return to heavy
drinking. Another older medication is disulfiram
(Antabuse®), which discourages drinking by causing nausea,
vomiting, and other unpleasant physical reactions when alcohol is
used.

Q #6: Does alcoholism treatment work?

Alcoholism treatment is effective in many cases. Studies show that a
minority of alcoholics remain sober 1 year after treatment, while
others have periods of sobriety alternating with relapses. Still others
are unable to stop drinking for any length of time. Treatment outcomes
for alcoholism compare favorably with outcomes for many other chronic
medical conditions. The longer one abstains from alcohol, the more
likely one is to remain sober.

It is important to remember that many people relapse once or several
times before achieving long-term sobriety. Relapses are common and do
not mean that a person has failed or cannot eventually recover from
alcoholism. If a relapse occurs, it is important to try to stop
drinking again and to get whatever help is needed to abstain from
alcohol. (See Question 12.) Ongoing support
from family members and others can be important in recovery.

Q #7: Does a person have to be alcoholic to experience
problems from alcohol?

No. Even if you are not alcoholic, abusing alcohol can have negative
results, such failure to meet major work, school, or family
responsibilities because of drinking; alcohol-related legal trouble;
automobile crashes due to drinking; and a variety of alcohol-related
medical problems. Under some circumstances, problems can result from
even moderate drinking–for example, when driving, during pregnancy, or
when taking certain medicines.

Q #8: Are certain groups of people more likely to develop
alcohol problems than others?

Yes. Nearly 14 million people in the United States–1 in every 13
adults–abuse alcohol or are alcoholic. However, more men than women
are alcohol dependent or experience alcohol-related problems. In
addition, rates of alcohol problems are highest among young adults ages
18-29 and lowest among adults 65 years and older. Among major U.S.
ethnic groups, rates of alcoholism and alcohol-related problems
vary.

Q #9: How can you tell whether you or someone close to you
has an alcohol problem?

A good first step is to answer the brief questionnaire below,
developed by Dr. John Ewing. (To help remember these questions, note
that the first letter of a key word in each question 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” answer suggests a possible alcohol problem. More than one
“yes” answer means it is highly likely that a problem exists. If you
think that you or someone you know might have an alcohol problem, it is
important to see a doctor or other health provider right away. He or
she can determine whether a drinking problem exists and, if so, suggest
the best course of action.

Q #10: If I have trouble with drinking, can’t I simply
reduce my alcohol use without stopping altogether?

That depends. If you are diagnosed as an alcoholic, the answer is
“no.” Studies show that nearly all alcoholics who try to merely cut
down on drinking are unable to do so indefinitely. Instead, cutting out
alcohol (that is, abstaining) is nearly always necessary for successful
recovery. However, if you are not alcoholic but have had
alcohol-related problems, you may be able to limit the amount you
drink. (See Question 13 for recommended limits.) If you cannot always stay within your limit,
you will need to stop drinking altogether.

Q #11: How can a person get help for an alcohol
problem?

You can call the Center for Substance Abuse Treatment at
1-800-662-HELP for information about treatment programs in your local
community and to speak to someone about an alcohol problem.

Many people also benefit from support groups. For information on
local support meetings run by Alcoholics
Anonymous (AA)
, call your local AA chapter (check your local phone
directory under “Alcoholism”) or call 212-870-3400. For meetings of Al-Anon (for spouses and other significant adults
in an alcoholic person’s life) and Alateen (for
children of alcoholics), call your local Al-Anon chapter or call the
following toll-free numbers: 1-800-344-2666 (United States) or
1-800-443-4525 (Canada).

Q #12: If an alcoholic is unwilling to seek help, is there any way to get him or her
into treatment?

This can be a challenging situation. An alcoholic cannot be forced
to get help except under certain circumstances, such as when a violent
incident results in police being called or following a medical
emergency. This doesn’t mean, however, that you have to wait for a
crisis to make an impact. Based on clinical experience, many alcoholism
treatment specialists recommend the following steps to help an
alcoholic accept treatment:

Stop all “rescue missions.” Family members
often try to protect an alcoholic from the results of his behavior by
making excuses to others about his drinking and by getting him out of
alcohol-related jams. It is important to stop all such rescue attempts
immediately, so that the alcoholic will fully experience the harmful
effects of his drinking–and thereby become more motivated to stop.

Time your intervention. Plan to talk with
the drinker shortly after an alcohol-related problem has occurred–for
example, a serious family argument in which drinking played a part or
an alcohol-related accident. Also choose a time when he or she is
sober, when both of you are in a calm frame of mind, and when you can
speak privately.

Be specific. Tell the family member that
you are concerned about his or her drinking and want to be supportive
in getting help. Back up your concern with examples of the ways in
which his or her drinking has caused problems for both of you,
including the most recent incident.

State the consequences. Tell the family
member that until he or she gets help, you will carry out
consequences–not to punish the drinker, but to protect yourself from
the harmful effects of the drinking. These may range from refusing to
go with the person to any alcohol-related social activities to moving
out of the house. Do not make any threats you are not prepared to carry
out.

Be ready to help. Gather information in
advance about local treatment options. If the person is willing to seek
help, call immediately for an appointment with a treatment program
counselor. Offer to go with the family member on the first visit to a
treatment program and/or AA meeting.

Call on a friend. If the family member
still refuses to get help, ask a friend to talk with him or her, using
the steps described above. A friend who is a recovering alcoholic may
be particularly persuasive, but any caring, nonjudgmental friend may be
able to make a difference. The intervention of more than one person,
more than one time, is often necessary to persuade an alcoholic person
to seek help.

Find strength in numbers. With the help of
a professional therapist, some families join with other relatives and
friends to confront an alcoholic as a group. While this approach may be
effective, it should only be attempted under the guidance of a
therapist who is experienced in this kind of group intervention.

Get support. Whether or not the alcoholic
family member seeks help, you may benefit from the encouragement and
support of other people in your situation. Support groups offered in
most communities include Al-Anon, which holds regular meetings for
spouses and other significant adults in an alcoholic’s life, and
Alateen, for children of alcoholics. These groups help family members
understand that they are not responsible for an alcoholic’s drinking
and that they need to take steps to take care of themselves, regardless
of whether the alcoholic family member chooses to get help.

For meeting locations, call your local Al-Anon chapter (check your
local phone book under “Alcoholism”) or call the following toll-free
numbers: 1-800-344-2666 (United States) or 1-800-443-4525 (Canada).

Q #13: What is a safe level of drinking?

Most adults can drink moderate amounts of alcohol–up to two drinks
per day for men and one drink per day for women and older people–and
avoid alcohol-related problems. (One drink equals one 12-ounce bottle
of beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of
80-proof distilled spirits.)

However, certain people should not drink at all. They include women
who are pregnant or trying to become pregnant; people who plan to drive
or engage in other activities requiring alertness and skill; people
taking certain medications, including certain over-the-counter
medicines; people with medical conditions that can be worsened by
drinking; recovering alcoholics; and people under the age of 21.

Q #14: Is it safe to drink during pregnancy?

No. Drinking during pregnancy can have a number of harmful effects
on the newborn, ranging from mental retardation, organ abnormalities,
and hyperactivity to learning and behavioral problems. Moreover, many
of these disorders last into adulthood. While we don’t yet know exactly
how much alcohol is required to cause these problems, we do know that
they are 100-percent preventable if a woman does not drink at all
during pregnancy. Therefore, for women who are pregnant or are trying
to become pregnant, the safest course is to abstain from alcohol.

Q #15: As people get older, does alcohol affect their bodies
differently?

Yes. As a person ages, certain mental and physical functions tend to
decline, including vision, hearing, and reaction time. Moreover, other
physical changes associated with aging can make older people feel
“high” after drinking fairly small amounts of alcohol. These combined
factors make older people more likely to have alcohol-related falls,
automobile crashes, and other kinds of accidents.

In addition, older people tend to take more medicines than younger
persons, and mixing alcohol with many over-the-counter and prescription
drugs can be dangerous, even fatal. (See Question 18.) Further, many medical conditions
common to older people, including high blood pressure and ulcers, can
be worsened by drinking. Even if there is no medical reason to avoid
alcohol, older men and women should limit their intake to one drink per
day.

Q #16: Does alcohol affect a woman’s body differently from a
man’s body?

Yes. Women become more intoxicated than men after drinking the same
amount of alcohol, even when differences in body weight are taken into
account. This is because women’s bodies have proportionately less water
than men’s bodies. Because alcohol mixes with body water, a given
amount of alcohol becomes more highly concentrated in a woman’s body
than in a man’s. That is why the recommended drinking limit for women
is lower than for men. (See Question 13 for recommended limits.)

In addition, chronic alcohol abuse takes a heavier physical toll on
women than on men. Alcohol dependence and related medical problems,
such as brain and liver damage, progress more rapidly in women than in
men.

Q #17: I have heard that alcohol is good for your heart. Is
this true?

Several studies have reported that moderate drinkers–those who have
one or two drinks per day–are less likely to develop heart disease
than people who do not drink any alcohol or who drink larger amounts.
Small amounts of alcohol may help protect against coronary heart
disease by raising levels of “good” HDL cholesterol and by reducing the
risk of blood clots in the coronary arteries.

If you are a nondrinker, you should not start drinking only to
benefit your heart. Protection against coronary heart disease may be
obtained through regular physical activity and a low-fat diet. And if
you are pregnant, planning to become pregnant, have been diagnosed as
alcoholic, or have any medical condition that could make alcohol use
harmful, you should not drink.

Even for those who can drink safely and choose to do so, moderation
is the key. Heavy drinking can actually increase the risk of heart
failure, stroke, and high blood pressure, as well as cause many other
medical problems, such as liver cirrhosis.

Q #18: If I am taking over-the-counter or prescription medication, do I have to stop
drinking?

Possibly. More than 100 medications interact with alcohol, leading
to increased risk of illness, injury and, in some cases, death. The
effects of alcohol are increased by medicines that slow down the
central nervous system, such as sleeping pills, antihistamines,
antidepressants, antianxiety drugs, and some painkillers. In addition,
medicines for certain disorders, including diabetes and heart disease,
can be dangerous if used with alcohol. If you are taking any
over-the-counter or prescription medications, ask your doctor or
pharmacist whether you can safely drink alcohol.

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