What is an alcoholic?

Alcoholics are people who cannot drink in moderation
consistently. Their pattern of drinking is uncontrollable and
usually compulsive. On one occasion an alcoholic may be able to
restrict himself to one drink, but s/he can never predict the
amount that s/he will drink on another occasion. Negative
occurrences do not deter the alcoholic from taking another drink.
They are not always intoxicated. They are not necessarily
continuous drinkers. They may develop physical dependence and
require hospital care to safely quit drinking.
The American Council on Alcoholism has published guidelines
defining the signs and symptoms of alcoholism. An alcoholic will
usually show several of these behaviors in his or her
life. For example, when the patient stops drinking suddenly,
s/he may have physical signs of withdrawal from alcohol. These
include trembling or shakiness, hallucinations, seizures, and
over-all feelings of bad health. Alcohol withdrawal is life-
threatening. Alcoholics often drink large amounts of alcohol
every day, as much alcohol as a fifth or more of hard liquor
daily. There is damage to body organs from this much alcohol such
as liver damage or brain damage. (1)
Recent studies suggest two types of alcoholism (2). "Type
I" alcoholism is seen in both sexes and is associated with
recurrent mild alcohol abuse. "Type II" alcoholism is seen
predominantly among males, has an early onset, and is frequently
associated with violent and antisocial behavior. What is called
"Type II alcoholism" may be only one symptom of an inherited
disease. This still-unnamed disease may cause an individual to
over-react to a wide range of stimuli, resulting in a cluster of
behavioral problems. For persons with the disease, the stimulus
of alcohol consumption could lead to alcohol abuse (3,4).
Unfortunately, it may not be easy to divide alcoholics into
such clean categories. Even after separating male alcoholics
into early onset (prior to age 26) and late onset (after age 26)
the majority of a sample of Veterans Administration patients
fufilled criteria for both Type I and Type II alcoholism. (5)
A change in behavior is often the first hint of alcohol-
related problems. Changing friends, increased conflicts at home,
and stockpiling or hiding supplies of alcoholic drinks are some
of the clues that signal an alcohol problem to family and
friends. The alcoholic usually has difficulty maintaining
relationships and jobs. Unexplained bouts with depression and
family problems may also suggest a problem with alcohol.
Physical signs of alcoholism include red bulbous nose, red face,
red palms, enlarged breasts in males, body scars, cigarette
burns, nicotine stains on fingers, muscle wasting, small
testicles, small red veins (spider angiomas), tremulousness,
puffy face, slurred speech, and swelling of the parotid glands.
Although these signs are not specific for alcoholism (and few
alcoholics display them all), they may serve as clues to
diagnose alcoholism.(6,7)
Alcoholics may also suffer from blackouts. These are
periods of time for which they have no memory, and yet are awake
and interacting with society.(8) An alcoholic who experiences
blackouts may awaken in a strange place the morning after a
drinking binge without any idea of how s/he arrived there.
The symptoms of alcoholism are subtle in the early stages of
the disease. Many alcoholics look and act normally, and remain
undiagnosed for years. Since seven percent of the US
population are alcoholics or are developing alcoholism, all of us
probably know one or more alcoholics.(9) The fact that most
people are unaware of the pervasiveness of alcoholism in society
suggests that the task of drug education is not yet complete.

REFERENCES

1. Criteria Committee. Criteria for the diagnosis of
alcoholism. Ann Int Med 1972; 77:249-258.

2. Cloninger CR, Bohman M, Siqvardsson S. Inheritance of
alcohol abuse: Cross-fostering analysis of adopted men.
Arch Gen Psychiatry 1981;38:861-868.

3. Pihl RO, Finn P, Peterson J. Autonomic hyperactivity and
risk for alcoholism. Prog Neuropsychopharmacol Biol
Psychiat 1989;13:489-96.

4. Pihl RO, Peterson J, Finn P. Inherited predisposition to
alcoholism; characteristics of sons of male alcoholics. J
Abnormal Psych 1990;99(3):291-301.

5. Penick EC, Powell BJ, Nickel EJ, et al. Examination of
Cloniger's Type I and Type II alcoholism with a sample of
men alcoholics in treatment. Alcoholism: Clinical &
Experimental Research 1990;14(4):623-9.

6. Whitfield CL. The patient with alcoholism and other drug
problems. 1982. Ridge Business Forms, Baltimore. p. 16.

7. Yersin B. Valeur et justification du depistage de
l'alcoolisme. Schweiz Med Wschr 1989; 120:1014-1024.

8. Charness ME, Simon RP, Greenberg DA. Ethanol and the
nervous system. New Engl J Med 1989; 321(7):442-451.

9. Brent RL. Teratologists, the fetal alcohol syndrome, and
alcohol addiction: are we doing enough? Teratology
1990;41:491-493.

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by Tony Tommasello, Trent Tschirgi, Mary Clinton, and Susan Wood.
(c) 1991 by Office of Substance Abuse Studies.
All Rights Reserved.

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