Alcoholism

Alcoholism is a chronic disease characterized by the use of alcohol with a pattern of harmful consequences, significant impairment or distress.


Understanding alcohol
Alcoholic beverages contain a class of alcohol known as ethyl alcohol (ethanol), which is produced by the fermentation of sugars in various grains and fruits. Drinking alcohol depresses the central nervous system, which can affect motor coordination, perspective and judgment. Habitual or excessive drinking can cause adverse psychological effects as well.
When a man and woman of equal age and weight consume the same amount of alcohol, the woman will have a higher blood alcohol content than the man. Here's why: Gastric alcohol dehydrogenase (GADH), an enzyme found in the stomach tissue, helps break down alcohol before it reaches the bloodstream. GADH activity is four times stronger in men than women. As a result, women typically become intoxicated with smaller quantities of alcohol than men.

Moderate drinking is generally defined as no more than two drinks per day for men and one drink per day for women. A standard drink is:

one 12-ounce beer or wine cooler
one 5-ounce glass of wine
1.5 ounces of 80-proof distilled spirits, with each drink containing 0.5 ounce or 12 grams of alcohol
Social drinking is a drinking pattern accepted by the society in which it occurs. It's not necessarily healthy or moderate, however.

Binge drinking is the consumption of five or more drinks in rapid succession for males or four or more drinks in rapid succession for females.

Eventually, tolerance may become an issue. With repeated and regular alcohol use, it takes more and more alcohol to achieve the desired effects.

Alcohol is often overlooked as a drug. According to the National Institute on Alcohol Abuse and Alcoholism, an estimated one in every 13 adults abuses alcohol or has alcoholism. Millions also engage in risky drinking patterns that could lead to alcohol problems.


Hangovers
A hangover is a group of unpleasant symptoms that develops after a bout of heavy drinking. Symptoms typically appear within several hours of the last drink and subside within eight to 24 hours. Symptoms may include:
fatigue
weakness
thirst
headaches and muscle aches
nausea, vomiting or stomach pain
disrupted sleep
sensitivity to light and sound
decreased ability to concentrate
tremors
sweating
increased pulse rate and systolic blood pressure
depression, anxiety or irritation
Home remedies for hangovers abound, but there are no scientifically proven "cures."


Alcohol poisoning
Alcohol poisoning is a severe and potentially fatal reaction to an alcohol overdose. When you consume excessive amounts of alcohol, your brain is deprived of oxygen. Eventually, this may cause your brain to shut down the involuntary functions that regulate breathing and heart rate.
Symptoms of alcohol poisoning include:

vomiting
unconsciousness
cold, clammy, pale or bluish skin
slow or irregular breathing

Causes/associated factors
Alcoholism tends to run in families. Men and women between ages 18 and 29 are at the highest risk for alcoholism. Other risk factors include:
simultaneous use of other drugs, such as nicotine or marijuana
excessive drinking at least once a week
peer pressure, especially for adolescents
history of psychiatric conditions, especially depression
family history of alcohol abuse, especially in first-degree relatives (such as parents and siblings)
major life events

Symptoms
Heavy drinking can affect your entire body by directly irritating body tissues, aggravating existing conditions, and interacting with other drugs or medications in your system. The social effects are extensive as well.
Many clues may indicate you have a problem with alcohol. For example:

You may deny or minimize your drinking -- or be ashamed and secretive about it.

You may experience personality changes while drinking.

Low self-esteem, defensiveness, anxiety and depression are common.

You may behave impulsively or have frequent accidents, falls or injuries.

You may continue drinking despite negative consequences.

The drinking may take increased time and effort at the expense of other obligations.

You may become aggressive, blaming, controlling, dishonest, manipulative or minimize the effects of your drinking.

You may drive while intoxicated or engage in other criminal behavior.

Difficulty with interpersonal relationships, failure to keep commitments, and developing a social circle of people who have alcohol problems are also possible.

Withdrawal
For those who stop drinking after continuous and heavy consumption of alcohol, withdrawal symptoms may appear up to four days after the last drink. Common withdrawal symptoms include:
nausea, vomiting or appetite loss
tremors or seizures
sweating
suicidal thoughts or threats
anxiety
agitation, which may be marked by fidgeting, restlessness, pacing or insomnia
headaches or a feeling of fullness in the head
disorientation
decreased ability to think or reason
disturbed sleep, which may last for months
Within one to two days of the last drink, some people experience:

a crawling sensation on or under the skin
auditory or visual hallucinations
seizures
About 5 percent of alcoholics experience delirium tremens (DTs) within the first two to four days without a drink. These withdrawal symptoms generally last one to three days and require emergency hospitalization. Complications may include:

a progressive increase in body temperature
dehydration
injuries
other related disorders
DTs are fatal for up to 15 percent of people who experience them.


Complications
Additional complications of heavy drinking may include:
for women, menstrual irregularities, impaired ovulation or infertility
for pregnant women, fetal alcohol syndrome (birth defects in a baby whose mother drank significant amounts of alcohol during pregnancy)
seizure disorders, dementia or delirium
blackouts
hepatitis, cirrhosis of the liver or fatty liver changes
gastritis (inflammation of the lining of the stomach) or pancreatitis (inflammation of the pancreas)
chronic diarrhea, stomach ulcers (open sores) or gastrointestinal bleeding
irregular heart rhythms, palpitations or cardiomyopathy (any disease affecting the structure and function of the heart)
cancer of the larynx (the voice box), esophagus (the tube connecting the stomach and throat), stomach or pancreas (the gland that produces some of the body's digestive enzymes -- proteins in the body that help create chemical reactions)
peripheral neuropathy (any syndrome characterized by muscle weakness and impaired reflexes, sharp pains, or a burning sensation in the hands and feet)
strokes
a shortened life span

Treatment
There are various approaches to alcoholism treatment.
Detoxification
For some people, treatment begins with a short stay in a detoxification center. Trained experts provide a safe and controlled withdrawal environment, sometimes with the help of medication. Such programs may offer treatment for coexisting problems, such as anxiety, malnutrition or underlying illnesses. They may also provide group and individual therapy sessions and make referrals to support groups.

Psychological therapy
Behavioral therapy stresses the importance of learning new coping skills. It may involve social skills training and a relapse prevention program. Sometimes a spouse or partner is included in therapy as well. In some cases, medication is recommended as well.

Medication therapy
Medication such as Naltrexone (ReVia, for example) may reduce your desire for alcohol. If you have a relapse, it's likely to be less severe. Another option may be disulfiram (Antabuse, for example). This medication will make you sick if combined with alcohol.

Additional support
Alcoholism recovery takes a lifetime. Indefinite abstinence from alcohol is the only resolution. To meet this challenge, people in recovery need strong support once they leave the hospital or treatment program.

Alcoholics Anonymous is an international organization based on a 12-step program centered around spiritual principles. Women for Sobriety is a similar organization with a holistic focus. Family and friends of those who have alcohol problems can look to Al-Anon, Alateen and Adult Children of Alcoholics for support. To find out about local groups, check the phone directory. Listings are also available online.


Prevention
If you have a family history of alcoholism or related risk factors, consider preventive counseling. Alcoholics Anonymous and related groups can provide emotional support, especially in crisis situations.