Smoking, Alcohol, and Substance Abuse
OVERVIEW OF ALCOHOL-RELATED PROBLEMS
Alcohol use is widespread, although the per capita consumption has
varied from decade to decade. While U.S. consumption of alcoholic
beverages increased after World II, since 1981 it has declined
slightly. But even with declines in alcohol use, two of three
American adults drink alcoholic beverages. About half of all alcohol
consumed in this country is ingested by heavy drinkers, estimated to
be between 6.5 and 10 percent of the total population. The extent
and frequency with which these individuals drink cause serious
health and behavioral problems—disrupting their own lives and that
of their family, friends, and employers—and also extracts a heavy
societal toll.
Alcohol use is involved in:
One-half of all murders, accidental deaths, and suicides
One-third of all drownings and boating and aviation deaths
One-half of all crimes
Almost half of all fatal automobile accidents
  The health problems associated with alcohol include brain damage,
cancer, heart disease, and cirrhosis of the liver.
 
  THE GENETICS OF ALCOHOL
Growing evidence supports the theory that heredity predisposes some
people toward alcoholism. This research has focused on mutations in
the molecular structures of enzymes that metabolize alcohol and may
affect the body's ability to excrete alcohol.
Researchers have found that the heredity of a large proportion of
Asians may prevent them from drinking: These people possess an
enzyme ineffective at removing acetaldehyde, the first by-product of
alcohol metabolism. When high levels of acetaldehyde build up after
consuming a small amount of alcohol, these people suffer discomfort
such as skin flushing and rapid pulse. Consequently, the presence of
this enzyme, which limits the alcohol that can be consumed before
illness ensues, may at least partly explain the low incidence of
alcoholism among Asian populations.
Studies of individuals with either an alcoholic mother or father or
both show that even if they are adopted, they still experience a
greater risk of developing alcoholism than the general population.
Similarly, offspring of nonalcoholic parents when adopted into
families with an alcoholic mother or father are less likely to
develop alcoholism than the children of alcoholics.
Two types of genetic predispositions have been theorized from
research.
Male-limited susceptibility. Found primarily in males, this
condition is passed on frequently and occurs at an early age. It
is associated with criminal tendencies and often requires
extensive therapy.
Milieu-limited susceptibility. More prevalent, this condition is
found in both males and females, is not as severe as
male-limited susceptibility, and does not necessarily involve
crime. Although inherited, it must be stimulated by
environmental factors to manifest itself.
 
  HOW ALCOHOL WORKS IN THE BODY
Alcohol is a potent nonprescription drug sold to anyone over the
national legal drinking age. This drug is a tranquilizer and a
member of the family of sedative-hypnotic drugs.
Temperate and occasional users of alcohol who are in normal health
do not appear to suffer negative effects from use of alcohol. In
moderate doses, alcohol has beneficial effects: relaxation, appetite
stimulation, and creation of a mild sense of euphoria.
Consumed in substantial amounts, alcohol's toxicity may be because
it acts as a foreign substance in the body's metabolism. The
short-term expression of this toxicity is felt as a hangover. The
long-term toxicity may develop into alcoholism and alcohol-related
diseases such as cirrhosis.
Unlike carbohydrates, fats, and proteins, which can be manufactured
by the body, alcohol is an introduced substance that is not
synthesized within the body. It is a food because it supplies a
concentrated number of calories, but it is not nourishing and does
not supply a significant amount of needed nutrients, vitamins, or
minerals—these are empty calories.
Most foods are prepared for digestion by the stomach so that their
nutrients can be absorbed by the large intestine, but 95 percent of
alcohol is absorbed directly through the stomach wall or the walls
of the duodenum and the small intestine.
Various factors affect the speed of alcohol's absorption into the
body.
Watery drinks such as beer are absorbed more slowly.
Foods (especially fatty foods) delay absorption.
Carbonated beverages speed up the emptying of the stomach into
the small intestine, where alcohol is absorbed more quickly.
The drinker's physical and emotional state (fatigue, stress) and
individual body chemistry unpredictably affect absorption.
Gender: women have less alcohol dehydrogenase, which breaks down
alcohol in the stomach, so more alcohol is absorbed into the
bloodstream.
  Alcohol moves from the bloodstream into every part of the body
that contains water, including major organs like the brain, lungs,
kidneys, and heart, and distributes itself equally both inside and
outside of cells. Only 5 percent of alcohol is eliminated from the
body through the breath, urine, or sweat; the rest is oxidized or
broken down in the liver.
In the liver:
Alcohol is broken down in steps by enzymes until only carbon
dioxide and water remain as by-products.
Alcohol is processed at the rate of 0.3 ounce of pure ethanol
per hour (less than 1 ounce of whiskey), and unprocessed alcohol
circulates in the body. (The alcohol from two cocktails—each
about 1.5 ounces—ingested before dinner is still present in the
body, in a diminished amount, 3 to 4 hours later.)
  The liver's fixed rate of alcohol breakdown means that drinking
coffee or taking a cold shower does not speed the sobering process.
Therefore, giving coffee to a person who is drunk may produce a
wide-awake drunk, a chilling prospect if the drunk and friends are
deluded into thinking the drinker is sober enough to drive a car.
Within moments of ingestion, alcohol reaches the brain where it:
Stimulates and agitates, initially producing euphoria
Depresses and sedates, producing calmness and tranquility
Anesthetizes
Induces a hypnotic state and sleep
  Alcohol quickly depresses inhibitions and judgment. As inhibitions
are released the drinker may feel friendlier, more gregarious, and
more expansive. The suggestion to "have a drink and loosen up" is
based on the biology of alcohol in the body. Sexual inhibitions may
be released, which gives alcohol the reputation as an aphrodisiac;
in fact, alcohol impairs sexual function and performance, and
eventually blunts desire. Increased consumption may produce Jekyll
and Hyde personality changes in drinkers, leading to aggressiveness
and cruelty. Radical mood changes (such as bouncing from euphoria to
self-pity) are also typical characteristics of intoxication.
Alcohol adversely affects motor ability, muscle function, reaction
time, eyesight, depth perception, and night vision. Since these are
the abilities needed to operate a motor vehicle and since even
moderate amounts of alcohol impair these abilities, drivers should
never— NEVER—drink and drinkers should not drive.
As a drinker continues to drink, alcohol depresses lung and heart
function, slowing breathing and circulation. Death can occur if
alcohol completely paralyzes breathing. However, this state is
seldom reached because the body rejects alcohol by vomiting, or the
drinker becomes comatose before he or she can imbibe a fatal dose.
Acute alcohol overdose leading to death occurs most often in
situations such as bars or college fraternities where individuals
may be encouraged to ingest large amounts of alcohol rapidly.
A hangover is a combination of physical symptoms.
Headache: Blood vessels in the head, dilated by alcohol,
painfully stretch as they return to their normal state.
Upset stomach: Alcohol irritates the gastric lining, leading to
acute gastritis.
Dehydration: Alcohol acts as a diuretic, stimulating the kidneys
to process and pass more water than is ingested.
  Hangover is a withdrawal state. If you medicate this withdrawal
with more alcohol, the alcohol will continue to circulate in the
blood and will not be completely eliminated. Taking amphetamines
(uppers) merely masks hangover symptoms.
The best hangover cure is aspirin, liquids, sleep, and time. Bland
foods, especially liquids, may also help. The best prevention for a
hangover is moderation or abstinence.
 
  PHYSICAL EFFECTS OF ALCOHOL ABUSE
Since alcohol so easily permeates every cell and organ of the body,
the physical effects of chronic alcohol abuse are wide-ranging and
complex. Large doses of alcohol invade the body's fluids and
interfere with metabolism in every cell. Alcohol damages the liver,
the central nervous system, the gastrointestinal tract, and the
heart. Alcoholics who do not quit drinking decrease life expectancy
by 10 to 15 years.
Alcohol also can impair vision, impair sexual function, slow
circulation, cause malnutrition, cause water retention (resulting in
weight gain and bloating), lead to pancreatitis and skin disorders
(such as middle-age acne), dilate blood vessels near the skin
causing "brandy nose," weaken the bones and muscles, and decrease
immunity.
The liver breaks down alcohol in the body and is therefore the chief
site of alcohol damage. Liver damage may occur in three irreversible
stages.
Fatty Liver. Liver cells are infiltrated with abnormal fatty
tissue, enlarging the liver.
Alcoholic Hepatitis. Liver cells swell, become inflamed, and
die, causing blockage. (Causes between 10 and 30 percent
mortality rate.)
Cirrhosis. Fibrous scar tissue forms in place of healthy cells,
obstructing the flow of blood through the liver. Various
functions of the liver deteriorate with often fatal results.
(Found in 10 percent of alcoholics.)
  A diseased liver:
Cannot convert stored glycogen into glucose, thus lowering blood
sugar and producing hypoglycemia.
Inefficiently detoxifies the bloodstream and inadequately
eliminates drugs, alcohol, and dead red blood cells.
Cannot manufacture bile (for fat digestion), prothrombin (for
blood clotting and bruise prevention), and albumin (for
maintaining healthy cells).
  Alcohol in the liver also alters the production of digestive
enzymes, preventing the absorption of fats and proteins and
decreasing the absorption of the vitamins A, D, E, and K. The
decreased production of enzymes also causes diarrhea.
 
  THE BRAIN AND CENTRAL NERVOUS SYSTEM
Alcohol profoundly disturbs the structure and function of the
central nervous system, disrupting the ability to retrieve and
consolidate information. Even moderate alcohol consumption affects
cognitive abilities, while larger amounts interfere with the oxygen
supply to the brain, a possible cause of blackout or temporary
amnesia during drunkenness. Alcohol abuse destroys brain cells,
producing brain deterioration and atrophy, and whether the organic
brain damage and neuropsychological impairment linked to alcohol can
be reversed is unknown. Alcohol also alters the brain's production
of RNA (a genetic "messenger"), and serotonin, endorphins, and
natural opiates whose function may be linked to the addictive
process.
A neurological disorder called Wernicke-Korsakoff's syndrome results
from vitamin B deficiencies produced by alcoholism and the direct
action of alcohol on the brain. Symptoms of this condition include
amnesia, loss of short-term memory, disorientation, hallucinations,
emotional disturbances, double vision, and loss of muscle control.
Other effects include mental disorders such as increased aggression,
antisocial behavior, depression, and anxiety.
  THE DIGESTIVE SYSTEM
Large amounts of alcohol may inflame the mouth, esophagus, and
stomach, possibly causing cancer in these locations, especially in
drinkers who smoke. Alcohol increases the stomach's digestive
enzymes, which can irritate the stomach wall, producing heartburn,
nausea, gastritis, and ulcers. The stomach of a chronic drinker
loses the ability to adequately move food and expel it into the
duodenum, leaving some food always in the stomach, causing sluggish
digestion and vomiting. Alcohol may also inflame the small and large
intestines.
  THE HEART
Moderate daily drinking may be good for the heart, but for many the
risks outweigh the benefits. Even one binge may produce irregular
heartbeats, and alcohol abusers experience increased risk of high
blood pressure, heart attacks, heart arrhythmia, and heart disease.
Alcohol may cause cardiomyopathy (a disease of the heart muscle).
Cessation of drinking aids recovery from this condition.
 
  WITHDRAWAL SYMPTOMS
Three to 6 days after a heavy drinker (drinking a fifth of liquor a
day) completely stops drinking, alcohol is finally gone from the
body, and acute and life-threatening effects may occur. Withdrawal
phenomena include sleep disorders such as insomnia, visual and
auditory hallucinations, disorientation, alcoholic convulsions,
epileptic seizures of the grand mal type, and delirium tremens
accompanied by acute anxiety and fear, agitation, fast pulse, fever,
and extreme perspiration. Consequently, alcoholics who decide to
quit drinking should do so under competent medical supervision.
 
  FETAL ALCOHOL SYNDROME
DEFINITION
Fetal alcohol syndrome (FAS) is a cluster of irreversible birth
abnormalities that are the direct result of heavy drinking during
pregnancy.
  CAUSE
Alcohol, like most other drugs, passes easily through the mother's
placenta and into the fetal bloodstream. In the fetus, the alcohol
depresses the central nervous system and must be metabolized by the
immature liver of the fetus, which cannot effectively process this
toxic substance. The alcohol stays in the fetus's body for a
prolonged time (even after leaving the mother's body) and the unborn
child remains intoxicated, possibly suffering withdrawal symptoms
after the alcohol is no longer present.
  DIAGNOSIS
Children born with fetal alcohol syndrome typically are smaller in
size, have smaller heads, and suffer deformities of limbs, joints,
fingers, and face, as well as heart defects. They may also have
cleft palate and poor coordination.
In some children, FAS does not appear until adolescence, when they
exhibit hyperactivity and learning and perceptual difficulties.
These impairments are symptomatic of minimal brain dysfunction
(MBD), which affects between 5 and 19 percent of schoolchildren,
according to a study by the National Institute of Alcohol Abuse and
Alcoholism. Studies of children with FAS who are now teenagers have
uncovered new physical problems—ear infections, hearing and vision
loss, and dental problems— that were not identified when the
children were first studied at a younger age.
Only a small percentage of the children born to alcoholic women
suffer FAS. The reasons for this are unknown, although it is thought
that some children have an increased genetic sensitivity to alcohol.
Maternal risk factors for this condition include:
Chronic drinking during pregnancy
Previous problems with drinking
Previous children
Being African-American
  Some studies have shown that female light-to-moderate drinkers
(so-called social drinkers) give birth to babies with subtle
alcohol-related neurological and behavioral problems. Although these
problems are less severe than those in children of heavy drinkers,
these findings indicate that lesser amounts of alcohol can also
cause developmental and behavioral abnormalities.
  TREATMENT AND PREVENTION
Pregnant women should abstain from all alcoholic beverages. Women
attempting to conceive should also abstain.
 
  PROFILE OF ALCOHOLISM
As noted previously, evidence indicates there may be genetic factors
that help determine whether a person will become an alcoholic. A
child of an alcoholic has four times the risk of becoming an
alcoholic compared with a child of nonalcoholic parents. However,
alcoholism is an equal opportunity disease, striking persons of
every economic class and race, both genders, and of many ages. Being
successful and happy at home or in business is no protection against
alcoholism.
For many years, alcoholics were viewed as morally defective persons
who were the objects of scorn and pity but were not seen as
suffering a disease. While the acceptance of this condition as a
disease clears the way for understanding, treatment, and recovery,
at the same time alcoholics can and must take responsibility for
their own recovery. And since alcoholism, like diabetes, is
treatable but not curable, recovery from alcoholism lasts a
lifetime.
 
  THE BEGINNING STAGES OF ALCOHOLISM
Like cancer, alcoholism consists of many diseases, and alcoholics
develop alcoholism in different ways. Some alcoholics begin drinking
to the point of intoxication from their first drink, immediately
behaving in ways destructive to health and relationships. Others
suffer a progressive disease, beginning with acceptable social
drinking. In the early stages of the condition, the alcoholic comes
quickly to depend on the mood-altering qualities of alcohol. Drinks
aid mood and are used to perk up, calm down, celebrate, mourn, be
sociable, or to withdraw. As the disease progresses, the alcoholic
does not need a specific reason to drink, and alcohol is ingested
every day, or at prescribed periodic times such as weekends.
In the beginning, alcoholics may start a party early by gulping a
few quick drinks in the kitchen or they may order doubles when
dining out. They feel uncomfortable at social occasions where
alcohol is missing. Consumption may be limited and controlled;
perhaps to two strong drinks before dinner, moving up to heavier
social drinking of three to five a day.
 
  MIDDLE STAGES
In the middle stages of alcoholism, the compulsion to begin drinking
manifests itself earlier in the day. The drinker prefers
alcohol-related activities and friends who drink. An increasing
tolerance for alcohol is accompanied by an increasing lack of
control, drunkenness, and blackouts, a type of amnesia that allows
functioning (such as making dinner or driving) but which blots out
memory of the occasion later on. Drinkers in the middle stages of
alcoholism may go in and out of a series of blackouts during one
drinking episode.
At this stage of alcoholism, the first drink of the day sets up a
craving for more, and the desire for alcohol overwhelms common sense
or what is socially appropriate. (Alcoholics Anonymous members say,
"It is the first drink that gets you drunk.") Loss of control while
drinking may not inevitably cause drunkenness each time (that is a
function of the unpredictability of the drinker's behavior), but
sooner or later, that "first drink" will lead to an episode of
overindulgence. As the disease progresses, the certainty of getting
drunk increases.
Drinkers in this stage begin to be secretly ashamed and worried
about lack of control. They may try to control their drinking or
stop completely, but these attempts often fail. They may switch
brands or kinds of alcohol and go from hard liquor to beer. They may
seek a "geographic cure," moving to a new city or job in an attempt
to cut down, or they may look fruitlessly for some other external
formula that will successfully alter their drinking behavior.
Eventually the alcoholic exhibits signs of denial, one of the chief
psychological symptoms of alcoholism. By refusing to accept the fact
of alcoholism, denial allows the drinker to keep drinking while
repressing inner conflict. In the midst of the growing problems
linked to alcohol consumption, drinkers blame everything except
alcohol for their plight. Rationalizations for drinking become
manifest, and unhappy relationships, financial difficulties, and
work problems are all blamed for the need to drink. What the drinker
fails to comprehend and denies strenuously is that the heavy
drinking is not the result of these problems but the cause.
Although drinkers claim they drink to relieve fatigue, anxiety, and
depression, alcohol, in large amounts, exacerbates these feelings.
Heavy drinking also brings out feelings of anger, self-loathing, and
lack of selfesteem and may produce rages expressed against family
members and friends.
As drinking progresses, alcoholics experience:
Stomach upset
Minor hand tremors
Increased tolerance for alcohol
Morning hangover and shaking hands that require tranquilizers or
alcohol to treat.
 
  FINAL STAGES
Persons suffering late-stage alcoholism finally grow obsessed with
alcohol to the exclusion of almost everything else. They drink
despite the pleading of family and the stern advice of doctors. They
may begin round-the-clock drinking despite an inability to keep down
the first drinks in the morning. Although relationships with family
and work may become completely severed, nothing, not even severe
health problems, is enough to deter drinking.
The late-stage alcoholic suffers a host of fears, including fear of
crowds and public places. Constant remorse and guilt is alleviated
with more drinking. On top of mental disturbances, debts, legal
problems, and homelessness may complicate his or her life. Latestage
addiction is characterized by cirrhosis and severe withdrawal
symptoms if alcohol is withheld (shakes, delirium tremens, and
convulsions). Without hospitalization or residency in a therapeutic
community, late-stage alcoholics usually succumb to insanity and
death.
People suffering alcoholism do not have to "hit bottom" and reach
the extreme late stages of alcoholism to decide to get help. Many
men and women have recognized their alcohol problems before they
lost their jobs or families, or began drinking in the morning,
suffered DTs, or had to be hospitalized. For them, the labels "early
stage," late stage," "problem drinker," or "alcoholic" were less
important than the fact that their growing powerlessness over
alcohol was causing them pain.
  DIAGNOSIS OF ALCOHOLISM
In some cases, the "diagnosis" of alcoholism is made by the courts,
as when a judge hands down a drunk driving sentence that includes a
requirement to attend Alcoholics Anonymous (AA), or to enter a
rehabilitation program. The emergency rooms of hospitals make such
diagnoses when a man or woman appears suffering from alcohol
poisoning or withdrawal. Some doctors, however, may miss the
diagnosis of alcoholism, in part because patients rarely admit to
excessive consumption; 50 percent of persons with alcoholism seen by
doctors are incorrectly diagnosed.
Families may diagnose alcoholism when a family member is
hospitalized for the disease or when a spouse leaves because of a
drinking problem. However, families may suffer from alcoholism
denial in which they completely or partially deny the problem.
 
  INITIAL-STAGE DENIAL

Excuses for the drinker's behavior are made to bosses, friends,
colleagues, or subordinates.
A pattern of lies is woven to cover up for lateness, missed
appointments, or irresponsibility.
The excuses and lies "enable" the alcoholic to continue drinking
and avoid consequences of his or her behavior.
 
  LATE-STAGE DENIAL

Family members lose perspective on the problem.
The alcoholic promises to stop drinking, then breaks the
promise; the alcoholic's spouse makes more demands in an attempt
to control the drinking.
The spouse of the alcoholic grows suspicious, angry, and
despairing.
The home environment grows deeply unhappy.
  In late-stage denial, the most helpful action for a spouse, family
member, or friend is to stop enabling the alcoholic. Alcoholics must
admit their problem, see that they are powerless over alcohol and
that alcohol has made their lives unmanageable. This realization is
difficult if the people around them protect them from the
consequences of their behavior. When family members let alcoholics
experience these doses of reality, without covering up, the
individual with the drinking problem may arrive at a personal moment
of truth.
Families and friends of alcoholics must do several things to help
the alcoholic stop drinking.
Abandon wishful thinking that the alcoholic will someday be able
to drink safely, recognizing that alcoholism is nearly always
progressive.
Stop enabling the alcoholic to continue drinking (stop covering
up for the drinker's irresponsible behavior).
Seek information about alcoholism and its treatment as a
disease.
 
  TREATMENT OF ALCOHOLISM
Alcoholism enjoys a good recovery rate once the alcoholic stops
drinking. Treatment takes many forms because there are many kinds of
alcoholics, each with special needs. Treatment sources include
hospitals, alcoholism units within hospitals, private clinics
designed solely for the care of alcoholics, residential alcoholic
rehabilitation facilities, self-help groups such as Alcoholics
Anonymous, and private practitioners such as alcoholism counselors,
psychologists, psychiatric social workers, and psychiatrists.
For a small number of alcoholics, a brief stay of 3 to 10 days in a
detoxification center may be necessary. Candidates for
detoxification are those who suffer withdrawal symptoms because of
the alcohol addiction. At the detox center (hospital unit,
nonmedical alcoholism facility, or other institution) the
alcoholic's body can clear itself of the alcohol's toxic effects.
The patient is cared for with rest, nutritious diet, abstinence from
alcohol, and careful medical attention, which may include medication
to reduce anxiety and manage withdrawal symptoms and psychiatric
evaluation to determine the presence or absence of treatable
psychiatric disorders such as depression or anxiety. Treating these,
however, will not treat the alcoholism, but not treating them is
likely to be associated with failure of the alcoholism treatment.
For long-term care, the alcoholic can recover at a rehabilitation
center or in the inpatient treatment unit of a hospital. These
centers provide alcohol-free environments; continued medical care;
group, individual, and family therapy; classes about alcoholism; and
regular Alcoholics Anonymous meetings.
Alcoholics Anonymous (AA) and its subgroups—Al-Anon for family
members of alcoholics and Alateen for teenage children of
alcoholics—are self-help organizations that provide experienced
advice and support for alcoholics and their families. From 7,000
responses to an informal survey the organization sent to its members
in the United States and Canada, 29 percent indicated they had
remained sober for more than 5 years, 38 percent for 1 to 5 years,
and 33 percent for less than 1 year. Sixty percent of the
respondents had sought counseling for alcoholism prior to joining
AA. While a scientific analysis of the sobriety success rate for AA
is difficult (the organization does not keep membership lists and
does not promote itself with sobriety rates), most experts recognize
AA as the core of any alcoholic therapy. The "12-step" approach of
AA has been widely copied in other selfhelp groups.
Outpatient care is also available to patients at rehab centers,
allowing individuals to return to work and home while receiving
therapy. These centers do not "dry out" alcoholics but provide
therapeutic settings in which a bridge back to a normal life can be
built.
Many alcoholics do not require detox centers or rehab programs but
start treatment with a thorough physical exam by a doctor to
diagnose possible alcohol-related conditions. The doctor can ease
the alcoholic's mind by giving him or her a clean bill of health or
by setting up a schedule of continuing care to manage chronic health
problems.
Early recovery from alcohol is marked by:
Occasional thoughts of drinking, especially at times of stress
or at cocktail hour. Although the compulsion to drink may be
absent, drink desires are a natural reminder of years of
drinking and should gradually diminish and need not be alarming.

Mood swings. Elation may yield to discouragement and tears.
Gradually these wide shifts of mood should moderate.
  To combat the early problems of recovery, the alcoholic should:
Receive plenty of patience from friends and family.
Take adequate rest and a nutritious diet.
Join a support group such as AA to share experiences with other
people suffering alcoholism.
  To help with sobriety, some alcoholics receive Antabuse
(disulfiram), a drug that intervenes in the liver's alcohol
metabolism, preventing the breakdown of acetaldehyde (an
intermediate product of alcohol metabolism). After the
administration of Antabuse, even a small sip of alcohol produces
acetaldehyde accumulation and nausea, vomiting, severe headache,
breathing difficulties, blurred vision, lowered blood pressure, and
feelings of impending death.
Antabuse use must be consented to by the recovering alcoholic with
the clear understanding of its effects. The drug neither alters the
alcoholic's mood nor removes urges to drink. Not an instant solution
or complete therapy, this drug deters drinking and can play a useful
part in treatment if it makes recovering alcoholics feel "protected"
from alcohol while learning to stay sober. Antabuse is administered
only until the recovering alcoholic feels ready to live without it;
it is not taken long term.
The narcotic antagonist Naltrexone has recently been approved by the
FDA for use in treating alcoholism. It appears to diminish alcohol's
pleasurable effects and thus helps keep a "lapse" from becoming a
"relapse." Like Antabuse, it is not a cure-all and should be given
in the context of relapse prevention training and supportive
counseling.
Mood-altering drugs such as tranquilizers may occasionally be
administered during recovery to quell anxiety. However, one drug
habit should not be substituted for another—tranquilizers may be
addicting. While some emotional conditions such as manic-depressive
psychosis require pharmacological solutions, sobriety should
generally be drug-free. This should not prevent individuals who need
medications, such as for severe depression, from taking them. While
some AA groups discourage even lithium or antidepressants, the
Central AA Council recognizes the important role such medications
can play for some recovering alcoholics.
 
  LIVING SOBER
Quitting drinking is only the first step in recovering from
alcoholism. Learning to live without alcohol requires adjustment in
attitudes, values, and lifestyles. If serious psychological
disturbances have developed because of drinking, psychiatric
counseling designed for alcohol abusers may be required.
Occupational rehabilitation or vocational guidance also may be
necessary.
Abstinence is the absence of alcohol or drugs; sobriety is a way of
life. Recovery begins where formal treatment leaves off, and this
lifelong process never ends. In developing a new way of life, many
factors play a part. Recovering alcoholics should avoid people,
places, and objects associated with their drinking. After being
sober for some time, alcoholics should make new friends and engage
in new activities by going to school, returning to work, learning a
new hobby, doing volunteer work, or renewing a lost association with
their churches or religious groups.
Positive addictions should be substituted for alcohol addiction:
Walking, jogging, sports, or a regular schedule of exercise promotes
well-being and self-esteem and provides a healthy outlet for energy.
Research indicates that exercise releases brain chemicals that
stimulate a natural high. Even a walk after dinner can act as a
tranquilizer that helps alleviate the urge for alcohol.
 
  PREVENTION OF ALCOHOL ABUSE
The National Institute on Alcohol Abuse and Alcoholism defines
moderate drinking as an average of not more than two drinks per day,
and estimates that 15 million adults (15 percent of the drinkers in
the United States) consume more than that amount. The 15 percent of
men and 3 percent of women who ingest more than four drinks a day
risk a serious drinking problem. Anyone, even safe drinkers, can
become a statistic when one night's overindulgence leads to a drunk
driving incident, a violent family argument, an incapacitating
hangover, or some other mishap.
Efforts at moderation do not have to be prohibitionist or
puritanical. Americans need to view moderation or abstinence as
life-enhancing choices rather than negative self-denial.
In a statement of goals, the U.S. Department of Health and Humans
Services has sought:
A freeze in the per capita consumption of alcohol
No increase in the proportion of adolescent drinkers
A reduction in the cirrhosis death rate and the number of deaths
from alcohol-related accidents
A reduction in the infants born with fetal alcohol syndrome
Increased general public and adolescent awareness of the risks
associated with alcohol abuse
  Because alcohol use is generally accepted in modern society and
alcohol is constantly available (while treatment for alcoholism is
not always easy to obtain), these goals present a constant
challenge. Most problem drinkers are not presently receiving formal
treatment apart from what AA offers. The available treatments are
most effective for socially stable, middle-class alcoholics and
least effective for the homeless without families.
The need to provide increased services of better quality to those
with alcoholism is urgent. The major burden of coping with this
complex drug problem continues to fall on the individuals and
families most directly affected. A further enlightened public policy
on alcoholism addressing legal drinking ages, liquor labeling, laws
governing drunk drivers, and public education is still necessary.
A variety of sources of information about alcoholism is available.
The Yellow Pages lists resources under "Alcoholism." Local chapters
of the National Council on Alcoholism provide information and
referrals. Alcoholics Anonymous and Al-Anon family groups are listed
in both the white and the Yellow Pages of the telephone directory.
For printed materials, contact the National Clearinghouse of the
National Institute on Alcohol Abuse and Alcoholism. (For more
information see appendix B, Directory of Health Organizations and
Resources.)
 
 

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