• Approximately 90% of adults in the U.S. drink alcohol
• Also known as alcohol dependence syndrome
• Alcoholism is only one type of an alcohol problem
• Most severe stage of a group of drinking problems
• Begins with binge drinking
  • men: having five or more drinks in 2 hours
  •  women: four or more in 2 hours
• Alcohol abuse
  • excessive drinking that causes health or social problems
  • not dependent on alcohol
  • haven't fully lost control over the use of alcohol
• The use of alcohol does not predict the development of alcoholism
• Is  treatable but not curable
• Can be fatal if left untreated
• Genetic, psychological and social factors can all contribute to the disease
• The term "alcoholism" was first used in 1849 by the physician Magnus Huss
• 54% of urban adults use alcohol at least once a month compared to 42% in nonurban areas
• No higher prevalence of alcoholism among adult welfare recipients than in the general population
• More than 700,000 Americans are being treated for alcoholism daily
• As many as half of American men have problems that are caused by alcohol.
• The World Health Organization estimates that about 140 million people throughout the world suffer from alcohol dependence.
• One in 12 adults in the United States abuse alcohol or are alcohol dependent.
• Studies show that people in north central U.S. are at highest risk for heavy drinking (6.4% heavy use and 19% binge drinking), and those in the Northeast have the lowest risk (4.5% heavy use and 13% binge drinking).
• More men than women are alcohol dependent or have alcohol problems
• Alcohol affects women differently than men
  • Women become more impaired after drinking the same amount despite body weight
  • Alcohol mixes with body water
  • Women's bodies have less water than men's bodies
  • Alcohol becomes more highly concentrated in a woman's body
  • Chronic alcohol abuse takes a heavier physical toll on women
• More than 150 medications interact harmfully with alcohol
• Long-term alcoholism itself may cause chemical changes that produce anxiety and depression

• Life style
• Friends
• Genetic predisposition
  • Irish and Native Americans are at higher risk
  • Jewish and Asian Americans have a lower risk.
  • May have a genetic susceptibility or invulnerability because of the way their bodies metabolize alcohol
  • Risk for alcoholism in sons of alcoholic fathers is 25%; for women, the link is weaker, but still present
• Abused as children
  • 72% of women and 27% of men with substance abuse disorders reported physical or sexual abuse or both.
  • They also had worse response to treatment than those without such a history.
• Beginning drinking at at age 14 or younger
• Men more likely than women to develop problems with alcolhol use
• Women:
  • Tend to drink more during the premenstrual period
  • Tend to become alcoholic later in life
  • Heavily influenced by their partner's drinking behavior
• Availability of alcohol  
• Family history: The risk of alcoholism is higher for people who had a parent or parents who abused alcohol.
• Emotional disorders
  • Being severely depressed
  • Having anxiety
  • Adults with attention-deficit/hyperactivity disorder
  • Strongly related to impulsive, excitable, and novelty-seeking behavior in children, who later become alcoholics
    • ADHD
    • Especially ADHD combined with Conduct Disorder
    • Thought to be due to having less fear of harmful (dangerous) situations

• Drinking alone or in secret
• Heavy, regular alcohol consumption
• Heavy cigarette smoking
• Being unable to control the amount of alcohol you drink
• Blacking out
• Making a ritual of having drinks ( e.g. before, with or after dinner)
• Becoming annoyed when drinking ritual is disturbed or questioned
• Losing interest in activities and hobbies
• Feeling a need to drink Irritability as normal drinking time nears, especially if alcohol isn't available
• Hiding alcohol
• Gulping drinks or ordering doubles
• Becoming intoxicated  to feel good or "normal"
• Accidents, violence
• Having problems with relationships, employment, finances or legally
• Recurrent absenteeism from work or school
• Needing to drink more to get the same effect
• Poor nutrition and personal neglect
• Spontaneous abortion, child with fetal alcohol syndrome
• Experiencing physical withdrawal symptoms — such as nausea, sweating and shaking — if you don't drink
• Other substance abuse (e.g., cannabis, cocaine, heroin, amphetamines, sedatives, hypnotics, and anxiolytics)
• Unexpected drug interactions
• Frequent falls or minor trauma (particularly in the elderly)

• Types
  • Type 1
    • More often women.
    • Typically become alcoholic at a later age
    • Have less severe symptoms or fewer psychiatric problems
    • Have a better outlook on life than those classified as type 2.
  • Type 2
    • More likely to be male.
    • Tend to become alcoholic at an early age
    • Have a high family risk for alcoholism
    • More severe symptoms
    • Negative outlook on life.

How can you tell if someone has a problem?

Answering the following four questions can help you find out if you or a loved one has a drinking problem:

• 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?

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 care provider right away. They can help you determine if a drinking problem exists and plan the best course of action. 

 (Courtesy of the National Institute on Alcohol Abuse and Alcoholism)

• Reasons alcoholics do not seek treatment
  • Don't believe treatment will work
  • Denial of the problem
  • Social stigma
• Alcoholism involves
  • Multiple factors which encourage a person to continue drinking
  • All factors must be addressed to successfully prevent a relapse
• Alcoholics who try to cut down on drinking rarely succeed.
• The effectiveness of alcoholism treatments varies widely.
  • One must consider the success rate based on those who enter a program, not just those who complete it.
    • Since completion of a program is the qualification for success, success among those who complete a program is generally near 100%.
    • Relapse rate must also be considered
      • Results should also be compared to the roughly 5% rate at which people will quit on their own.
      • A year after completing a rehab program, about a third of alcoholics are sober, an additional 40 percent are substantially improved but still drink heavily on occasion, and a quarter have completely relapsed
• Cutting out alcohol--that is, abstaining--is usually the best course for recovery.
  • People who are not alcohol dependent but who have experienced alcohol-related problems may be able to limit the amount they drink.
  • If they can't stay within those limits, they need to stop drinking altogether.
• Intervention 
  • Effective in motivating a person to quit/reduce drinking over the short term
  • Goal should be to encourage alcoholic to seek long term treatment
  • Personal Intervention
    • Stop all "cover ups." Family members often make excuses to others or try to protect the alcoholic from the results of his or her drinking. It is important to stop covering for the alcoholic so that he or she experiences the full consequences of drinking.
    • Time your intervention. The best time to talk to the drinker is shortly after an alcohol-related problem has occurred--like a serious family argument or an accident. Choose a time when he or she is sober, both of you are fairly calm, and you have a chance to talk in private.
    • Be specific. Tell the family member that you are worried about his or her drinking. Use examples of the ways in which the drinking has caused problems, including the most recent incident.
    • State the results. Explain to the drinker what you will do if he or she doesn't go for help--not to punish the drinker, but to protect yourself from his or her problems. What you say may range from refusing to go with the person to any social activity where alcohol will be served, to moving out of the house. Do not make any threats you are not prepared to carry out.
    • Get help. Gather information in advance about treatment options in your community. If the person is willing to get help, call immediately for an appointment with a treatment counselor. Offer to go with the family member on the first visit to a treatment program and/or an Alcoholics Anonymous 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 just described. A friend who is a recovering alcoholic may be particularly persuasive, but any person who is caring and nonjudgmental may help. The intervention of more than one person, more than one time, is often necessary to coax an alcoholic to seek help.
    • Find strength in numbers. With the help of a health care professional, some families join with other relatives and friends to confront an alcoholic as a group. This approach should only be tried under the guidance of a health care professional who is experienced in this kind of group intervention.
    • Get support. It is important to remember that you are not alone. 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, which is geared to 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.
  • Employer Intervention
    • approach should also be compassionate
    • May threaten the employee with loss of employment if they do not seek help.
    • Somecompanies provide access to inexpensive/ free treatment programs
•  Detoxification
  • Abrupt stop of alcohol drinking coupled with the substitution of drugs to prevent alcohol withdrawal.
  • Treats the physical effects of prolonged use of alcohol
  • Does not actually treat alcoholism
  • Relapse is likely without further treatment.
  • Rehabilitations (or 'rehabs') may take place in an inpatient or outpatient setting.
• Group therapy or psychotherapy
  • After detoxification
  • Used to deal with underlying psychological issues related to alcohol addiction
  • Provides relapse prevention skills
  • Mutual-help group-counseling approach
    • Most common way of helping alcoholics maintain sobriety.
    • Alcoholics Anonymous
    • LifeRing Secular Recovery
    • Rational Recovery
    • SMART Recovery
    • Women For Sobriety
    • Al-Anon/Alateen
• Inpatient Treatment
  • At a general or psychiatric hospital or a center dedicated to treatment of alcohol and other substance abuse.
  • Recommended for people with:
    • Other medical or psychiatric disorder
    • With delirium tremens
    • For those who may harm themselves or others
    • For those who have not responded to conservative treatments
    • For those who have a disruptive home environment
  • Typical treatment plan
    • A physical and psychiatric work-up to evaluate other physical or mental disorders
    • Detoxification
    • Treatment with medications
    • Psychotherapy
    • An introduction to outside support groups
• Outpatient Treatment
  • For people with mild to moderate withdrawal symptoms
  • Done at a doctor's office or dedicated treatment center
  • Some studies show that this can be as effective as inpatient treatment
  • Medical Management
    • Treats alcoholism as a chronic illness
    • Regular 20-minute sessions with a health care provider
    • Monitors the patient’s medical condition, medication, and alcohol consumption.
    • Most effective when combined with:
      • Drug treatment with naltrexone (ReVia, Vivitrol), or
      • Behavioral counseling with a therapy technique called combined behavioral intervention (CBI)
• Medications
  • Used in conjuection with one of the above treatments
  • Anticraving drugs
    • Reduce the effects and urge to drink alcohol
    • Naltrexone (ReVia, Vivitrol)
      • Short term for people with low-to-moderate alcohol dependency.
      • ReVia
        • Pll that
        • Taken daily
      • Vivitrol:
        • Once-a-month shot
        • Injected in the buttocks
        • For people receiving counseling and who haven't had a drink for at least a week.
    • Acamprosate (Campral)
      • Blocks neurotransmitters
      • People with kidney problems should use carefully
  • Aversion medications
    • Causes unpleasant side effects when mixed with alcohol
      • Disulfiram (Antabuse)
        • Causes flushing, headache, nausea, and vomiting when combined with alcolhol
        • May last from half an hour to 2 hours, depending on dosage of the drug and the amount of alcohol consumed
        • One dose is usually effective for 1 - 2 weeks
  • Topiramate (Topamax)
    • Effective in helping alcoholics quit or cut back on the amount they drink I
    • Works by reducing dopamine so that drinking is no longer pleasurable
    • Only medication shown to be effective for persons who are still drinking.

• Acupuncture
• St John's Wort
• Kudzu root

• Know and acknowledge family history of alcohol abuse
• Early intervention for children and teens
  • Educate children and teens
    • Support your teens and give them space to grow.
      • Be involved in your teens’ lives. Be loving and caring.
      • Encourage your teens’ growing independence, but set appropriate limits.
      • Make it easy for your teens to share information about their lives.
      • Know where your teens are, what they’re doing, who they’re with, and who their
        friends are.
      • Find ways for your teens to be involved in family life, such as doing chores or caring
        for a younger brother or sister.
      • Set clear rules, including rules about alcohol use. Enforce the rules you set.
    • Talk with your teens about alcohol use
      • When you talk with your teens about drinking, listen to them and respect what they say.
      • Make clear your expectation that your teens will not drink.
      • Teach your children about the dangers of underage drinking.
      • Discuss laws about underage drinking, including the age 21 law.
    • Help your teens make good decisions about alcohol.
      • Help your teens know how to resist alcohol.
      • Help them find ways to have fun without alcohol.
      • Do not give alcohol to your teens.
      • Tell them that any alcohol in your home is off
        limits to them and to their friends.
      • Don’t let your teens attend parties where alcohol is served.
      • Make sure alcohol isn’t available at teen parties in your own home.
      • Set clear rules about not drinking and enforce them consistently.
        Help your teens avoid dangerous situations such as riding in a car driven by someone
        who has been drinking.
      • Help your teens get professional help if you’re worried about their involvement
        with alcohol.
    • Parents should be aware of warning signs
      • Loss of interest in activities and hobbies
      • Bloodshot eyes, slurred speech and memory lapses
      • Change in friends
      • Falling grades
      • Problems in school
      • Frequent mood changes
      • Defensive behavior
  • Parents should network with other parents to watch for alcohol abuse
  • Parents should set a good example

• SSRIs. Research is under way to determine which individuals with alcoholism might best respond to SSRIs. For example, one study suggested that they may be more effective for men than women. Some may be specifically helpful for people with both alcoholism and certain anxiety disorders, such as social anxiety.

• Designer Antidepressants. Drugs have now been developed that target other neurotransmitters, such as norepinephrine, alone or in addition to serotonin. They include nefazodone (Serzone), venlafaxine (Effexor), and mirtazapine (Remeron). Some research suggests they may have some benefits for treating alcoholism. However, nefazodone has been linked to increased risk for liver damage and should be used with caution by people with alcohol dependence.

This article includes information from: National Institute on Alcohol Abuse and Alcoholism (www.niaaa.gov) National Council on Alcoholism and Drug Dependence, (www.ncadd.org)