Alcohol Abuse and Alcoholism

by Debra Wood, RN

Definition

Alcohol abuse is excessive or problematic alcohol consumption. It can progress to alcoholism.

Alcoholism is chronic alcohol abuse that results in a physical dependence on alcohol (withdrawal symptoms) and an inability to stop or limit drinking.

Causes

Several factors can contribute to alcohol abuse and alcoholism, including:

• Genes
• Brain chemicals that may be different than normal
• Social pressure
• Emotional stress
• Pain
• Depression and other mental health problems
• Problem drinking behaviors learned from family or friends

Risk Factors

These factors increase your chance of developing alcoholism. Tell your doctor if you have any of these risk factors:

• Sex: male
• Family members who abuse alcohol (especially men whose fathers or brothers are alcoholic)
• Starting to use alcohol at an early age (younger than 14)
• Using illicit drugs or non-medical use of prescription drugs
• Peer pressure
• Easy access to alcoholic beverages
• Psychiatric disorders, such as depression or anxiety
• Smoking

Symptoms

It is common to deny an alcohol problem. Alcohol abuse can occur without physical dependence.

Alcohol abuse symptoms include:

• Repeated work, school, or home problems due to drinking
• Risking physical safety
• Recurring trouble with the law, often including drinking and driving
• Continuing to drink despite alcohol-related difficulties

Symptoms of alcoholism include:

• Craving a drink
• Unable to stop or limit drinking
• Needing greater amounts of alcohol to feel the same effect
• Giving up activities in order to drink or recover from alcohol
• Drinking that continues even when it causes or worsens health problems
• Wanting to stop or reduce drinking, but not being able
• Withdrawal symptoms if alcohol is stopped include:
  • Nausea
  • Sweating
  • Shaking
  • anxiety
  • Increased blood pressure
  • Seizures ( delirium tremens [DTs])

The brain, nervous system, heart, liver, stomach, gastrointestinal tract, and pancreas can all be damaged by alcoholism.

Some of the Organs Damaged in Alcohol Abuse

Diagnosis

Doctors ask a series of questions to assess possible alcohol-related problems, including:

• Have you tried to reduce your drinking?
• Have you felt bad about drinking?
• Have you been annoyed by another person's criticism of your drinking?
• Do you drink in the morning to steady your nerves or cure a hangover?
• Do you have problems with a job, your family, or the law?
• Do you drive under the influence of alcohol?

Blood tests may be done to:

• Look at the size of your red blood cells and to check for a substance called carbohydrate-deficient transferrin
• Check for alcohol-related liver disease and other health problems

Treatment

Treatment for alcohol abuse or dependence is aimed at teaching patients how to manage the disease. Most professionals believe that this means giving up alcohol completely and permanently.

The first and most important step is recognizing a problem exists. Successful treatment depends on your desire to change. Your doctor can help you withdraw from alcohol safely. This could require hospitalization in a detoxification center. They will carefully monitor you for side effects. You may need medication while you are undergoing detoxification.

Treatments include:

Medications

Drugs can help relieve some of the symptoms of withdrawal and help prevent relapse. The doctor may prescribe medication to reduce cravings for alcohol.

Medications used to treat alcoholism and to try to prevent drinking include:

• Naltrexone (ReVia)—blocks the high that makes you crave alcohol
• Disulfiram (Antabuse)—makes you very sick if you drink alcohol
• Acamprosate (Campral)—reduces your craving for alcohol

A study showed that an anticonvulsant drug, topiramate (Topamax), may reduce alcohol dependence.

Education and Counseling

Therapy helps you to recognize alcohol's dangers. Education raises awareness of underlying issues and lifestyles that promote drinking. In therapy, you work to improve coping skills and learn other ways of dealing with stress or pain.

Mentoring and Community Help

Alcoholics Anonymous (AA) helps many people to stop drinking and stay sober. Members meet regularly and support each other. Your family members may also benefit from attending meetings of Al-Anon. Living with an alcoholic can be a painful, stressful situation.

Here are some general statistics on treatment outcomes of individuals one year after attempting to stop drinking:

• 1/3 remained abstinent
• 1/3 resumed drinking but at a lower level
• 1/3 relapsed completely

If you are diagnosed with alcohol abuse or alcoholism, follow your doctor's instructions.

Prevention

Realizing that alcohol causes problems helps some people avoid it. Suggestions to decrease the risk of alcohol abuse and dependence include:

• Socialize without alcohol.
• Avoid going to bars.
• Do not keep alcohol in your home.
• Avoid situations and people that encourage drinking.
• Make new nondrinking friends.
• Do fun things that do not involve alcohol.
• Avoid reaching for a drink when stressed or upset.
• Limit your alcohol intake to a moderate level.
  • Moderate is two or fewer drinks per day for men and one or fewer for women and older adults
  • A 12-ounce bottle of beer, a five-ounce glass of wine, or 1.5 ounces of liquor is considered one drink

Most professionals who treat alcohol abuse and dependence believe that complete abstinence is the only effective "prevention."

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