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Alcoholism and alcohol abuse

Definition

Alcoholism and alcohol abuse are two types of problem drinking.

Alcoholism is when your drinking causes serious problems in your life, yet you keep drinking. You also may have a physical dependence on alcohol. This means that you need more and more alcohol to feel drunk. Stopping suddenly may cause withdrawal symptoms.

Alcohol abuse is when your drinking leads to problems, but you are not physically dependent on alcohol. These problems may occur:

  • At work, school, or home
  • In your personal relationships
  • With the law
  • From using alcohol in dangerous situations, such as drinking and driving

Alternative Names

Alcohol dependence; Alcohol abuse; Problem drinking; Drinking problem; Alcohol addiction

Causes

No one knows what causes problems with alcohol. Health experts think that it may be a combination of a person’s:

  • Genes
  • Environment
  • Psychology, such as being impulsive or having low self-esteem

Drinking a lot of alcohol can put you at risk for alcohol problems. You are more at risk for alcoholism if:

  • You are a man who has 15 or more drinks a week
  • You are a woman who has 12 or more drinks a week
  • You have five or more drinks at a time at least once a week

One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor.

If you have a parent with alcoholism, you are more at risk for alcohol problems.

You also may be more likely to abuse alcohol or become dependent if:

  • You are a young adult under peer pressure
  • You have depression, bipolar disorder, anxiety disorders, or schizophrenia
  • You have easy access to alcohol
  • You have low self-esteem
  • You have problems with relationships
  • You live a stressful lifestyle

Alcohol abuse is on the rise. In the U.S., about 3 out of 10 people drink at a level that puts them at risk for alcoholism.

If you are concerned about your drinking, it may help to take a careful look at your alcohol use.

Symptoms

If you have a drinking problem, you may:

  • Continue to drink, even when your health, work, or family are being harmed
  • Drink alone
  • Become stirred up, excited, or tense when drinking
  • Become hostile when asked about your drinking
  • Make excuses to drink
  • Miss work or school, or don’t perform as well because of drinking
  • Stop taking part in activities you enjoy because of alcohol
  • Need to use alcohol on most days to get through the day
  • Don’t eat a lot or eat poorly
  • Not care about how you dress or if you are clean
  • Try to hide alcohol use
  • Shake in the morning or after periods when you have not had a drink

Symptoms of alcohol dependence include:

Exams and Tests

Your health care provider will:

  • Examine you
  • Ask questions about your medical and family history
  • Ask about your alcohol use

These questions from the National Institute on Alcohol Abuse and Alcoholism can help screen for an alcohol problem:

  • Do you ever drive when you have been drinking?
  • Do you have to drink more than before to get drunk or feel the desired effect?
  • Have you felt that you should cut down on your drinking?
  • Have you ever had any blackouts after drinking?
  • Have you ever missed work or lost a job because of drinking?
  • Is someone in your family worried about your drinking?

Your health care provider may order tests to check for health problems that are common in people who abuse alcohol. These tests may include:

Treatment

Many people with an alcohol problem need to completely stop using alcohol. This is called abstinence. Having strong social and family support can help make it easier to quit drinking.

Some people are able to just cut back on their drinking. So even if you don’t give up alcohol altogether, you may be able to drink less. This can improve your health and relationships with others. It can also help you perform better at work or school.

However, many people who drink too much find they can’t just cut back. Abstinence may be the only way to manage a drinking problem.

DECIDING TO QUIT

Like many people with an alcohol problem, you may not recognize that your drinking has gotten out of hand. An important first step is to be aware of how much you drink. It also helps to understand the health risks of alcohol.

If you decide to quit drinking, talk with your health care provider. Treatment involves helping you realize how much your alcohol use is harming your life and the lives those around you.

Depending on how much and how long you’ve been drinking, you may be at risk for alcohol withdrawal. Withdrawal can be very uncomfortable and even life-threatening. If you have been drinking a lot, you should cut back or stop drinking only under the care of a doctor. Talk with your health care provider about how to stop using alcohol.

LONG-TERM SUPPORT

Alcohol recovery or support programs can help you stop drinking completely. These programs usually offer:

  • Education about alcoholism and its effects
  • Counseling and therapy to discuss how to control your thoughts and behaviors
  • Physical health care

For the best chance of success, you should live with people who support your efforts to avoid alcohol. Some programs offer housing options for people with alcohol problems. Depending on your needs and the programs that are available:

  • You may be treated in a special recovery center (inpatient)
  • You may attend a program while you live at home (outpatient)

You may be prescribed medicines to help you quit. They are often used with long-term counseling or support groups.

These drugs make it less likely that you will drink again or help limit the amount you drink.

  • Acamprosate may help prevent relapse.
  • Disulfiram (Antabuse) produces very unpleasant side effects if you drink even a small amount of alcohol.
  • Naltrexone (Vivitrol) decreases alcohol cravings. It is available in a pill or as an injection.

Drinking may mask depression or other mood or anxiety disorders. If you have a mood disorder, it may become more noticeable when you stop drinking. Your health care provider will treat any mental disorders in addition to your alcohol treatment.

Support Groups

Support groups help many people who are dealing with alcoholism.

ALCOHOLICS ANONYMOUS (AA)

Alcoholics Anonymous is a self-help group of recovering alcoholics. Meetings offer emotional support and specific steps for people recovering from alcohol abuse or dependence. The program is commonly called a "12-step" approach. There are local chapters throughout the U.S. AA offers help 24 hours a day.

AL-ANON

Family members of a person with an alcohol problem often benefit from talking with others. Al-Anon is a support group for people who are affected by another person's drinking problem.

Alateen provides support for teenage children of people with alcoholism.

OTHER SUPPORT GROUPS

Several other support groups are available.

  • SMART recovery teaches ways to change thoughts and behaviors to help people recover from alcoholism.
  • LifeRing recovery and Secular Organizations for Sobriety (SOS) are two non-religious programs that offer support for people with alcoholism.
  • Women for Sobriety is a self-help group just for women.
  • Moderation Management is a program for those who want to reduce how much they drink. It recommends abstinence for people who cannot do this.

Outlook (Prognosis)

How well a person with alcoholism or alcohol abuse does depends on whether they can successfully cut back or stop drinking.

It may take several tries to stop drinking for good. If you are struggling to quit, don’t give up hope. Getting treatment, if needed, along with support and encouragement from support groups and those around you can help you remain sober.

Possible Complications

Alcoholism and alcohol abuse can increase your risk of many health problems, including:

  • Bleeding in the digestive tract
  • Brain cell damage
  • A brain disorder called Wernicke-Korsakoff syndrome
  • Cancer of the esophagus, liver, colon, and other areas
  • Changes in the menstrual cycle
  • Delirium tremens (DTs)
  • Dementia and memory loss
  • Depression and suicide
  • Erectile dysfunction
  • Heart damage
  • High blood pressure
  • Inflammation of the pancreas (pancreatitis)
  • Liver disease, including cirrhosis
  • Nerve damage
  • Poor nutrition
  • Sleeping problems (insomnia)
  • Sexually transmitted infections (STIs)

Alcohol use also increases your risk for violence.

Drinking alcohol while you are pregnant can lead to severe birth defects in the baby. This is called fetal alcohol syndrome.

When to Contact a Medical Professional

Talk with your doctor if you or someone you know may have an alcohol problem.

Seek immediate medical care or call your local emergency number (such as 911) if you or someone you know has alcohol dependence and develops severe confusion, seizures, or bleeding.

Prevention

The National Institute on Alcohol Abuse and Alcoholism recommends:

  • Women should not drink more than 1 drink per day
  • Men should not drink more than 2 drinks per day

References

US Preventive Services Task Force. Recommendation statement: Screening and behavioral counseling interventions in primary care to reduce alcohol misuse. Rockville, MD; April 2004. Accessed February 19, 2012.

Jonas DE, Garbutt JC, Amick HR, Brown JM, Brownley KA, Council CL, et al. Behavioral Counseling After Screening for Alcohol Misuse in Primary Care: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2012 Sep 25.

Kleber HD, Weiss RD, Anton RF Jr., George TP, Greenfield SF, Kosten TR, et al. Work Group on Substance Use Disorders; American Psychiatric Association; Steering Committee on Practice Guidelines. Treatment of patients with substance use disorders, second edition. Am J Psychiatry. 2007;164:5-123.

In the clinic. Alcohol use. Ann Intern Med. 2009 Mar 3;150(5):

O'Connor PG. Alcohol abuse and dependence. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 32.

Schuckit MA. Alcohol-use disorders. Lancet. 2009;373:492-501.


Review Date: 2/9/2013
Reviewed By: David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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