ALCOHOLISM
Getting the Facts
For many people, the facts about alcoholism are not clear. What is alcoholism, 
exactly? How does it differ from alcohol abuse? When should a person seek help 
for a problem related to his or her drinking? The National Institute on Alcohol 
Abuse and Alcoholism (NIAAA) has prepared this booklet to help individuals and 
families answer these and other common questions about alcohol problems. The 
information below will explain alcoholism and alcohol abuse, symptoms of each, 
when and where to seek help, treatment choices, and additional helpful 
resources.



A Widespread Problem 
For most people, alcohol is a pleasant accompaniment to social activities. 
Moderate alcohol use--up to two drinks per day for men and one drink per day for 
women and older people (A standard drink is one 12-ounce bottle of beer or wine 
cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits) 
-- is not harmful for most adults. Nonetheless, a substantial number of people 
have serious trouble with their drinking. Currently, nearly 14 million 
Americans--1 in every 13 adults--abuse alcohol or are alcoholic. Several million 
more adults engage in risky drinking patterns that could lead to alcohol 
problems. In addition, approximately 53 percent of men and women in the United 
States report that one or more of their close relatives have a drinking problem. 

The consequences of alcohol misuse are serious--in many cases, life-threatening. 
Heavy drinking can increase the risk for certain cancers, especially those of 
the liver, esophagus, throat, and larynx (voice box). It can also cause liver 
cirrhosis, immune system problems, brain damage, and harm to the fetus during 
pregnancy. In addition, drinking increases the risk of death from automobile 
crashes, recreational accidents, and on-the-job accidents and also increases the 
likelihood of homicide and suicide. In purely economic terms, alcohol-use 
problems cost society approximately $100 billion per year. In human terms, the 
costs are incalculable.



What Is Alcoholism? 
Alcoholism, which is also known as "alcohol dependence syndrome," is a disease 
that is characterized by the following elements: 
Craving: A strong need, or compulsion, to drink. 
    Loss of control: The frequent inability to stop drinking once a person has 
    begun. 
    Physical dependence: The occurrence of withdrawal symptoms, such as nausea, 
    sweating, shakiness, and anxiety, when alcohol use is stopped after a period 
    of heavy drinking. These symptoms are usually relieved by drinking alcohol 
    or by taking another sedative drug. 
    Tolerance: The need for increasing amounts of alcohol in order to get 
    "high." 
    Alcoholism has little to do with what kind of alcohol one drinks, how long one 
has been drinking, or even exactly how much alcohol one consumes. But it has a 
great deal to do with a person's uncontrollable need for alcohol. This 
description of alcoholism helps us understand why most alcoholics can't just 
"use a little willpower" to stop drinking. He or she is frequently in the grip 
of a powerful craving for alcohol, a need that can feel as strong as the need 
for food or water. While some people are able to recover without help, the 
majority of alcoholic individuals need outside assistance to recover from their 
disease. With support and treatment, many individuals are able to stop drinking 
and rebuild their lives. Many people wonder: Why can some individuals use 
alcohol without problems, while others are utterly unable to control their 
drinking? Recent research supported by NIAAA has demonstrated that for many 
people, a vulnerability to alcoholism is inherited. Yet it is important to 
recognize that aspects of a person's environment, such as peer influences and 
the availability of alcohol, also are significant influences. Both inherited and 
environmental influences are called "risk factors." But risk is not destiny. 
Just because alcoholism tends to run in families doesn't mean that a child of an 
alcoholic parent will automatically develop alcoholism.



What Is Alcohol Abuse? 
Alcohol abuse differs from alcoholism in that it does not include an extremely 
strong craving for alcohol, loss of control, or physical dependence. In 
addition, alcohol abuse is less likely than alcoholism to include tolerance (the 
need for increasing amounts of alcohol to get "high"). Alcohol abuse is defined 
as a pattern of drinking that is accompanied by one or more of the following 
situations within a 12-month period: 
Failure to fulfill major work, school, or home responsibilities; 
    Drinking in situations that are physically dangerous, such as while driving 
    a car or operating machinery; 
    Recurring alcohol-related legal problems, such as being arrested for driving 
    under the influence of alcohol or for physically hurting someone while 
    drunk; 
    Continued drinking despite having ongoing relationship problems that are 
    caused or worsened by the effects of alcohol. 
    While alcohol abuse is basically different from alcoholism, it is important to 
note that many effects of alcohol abuse are also experienced by alcoholics.



What Are the Signs of a Problem? 
How can you tell whether you, or someone close to you, may have a drinking 
problem? Answering the following four questions can help you find out. (To help 
remember these questions, note that the first letter of a key word in each of 
the four questions spells "CAGE.") 
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 (Eye opener)? 
    One "yes" response suggests a possible alcohol problem. If you responded "yes" 
to more than one question, it is highly likely that a problem exists. In either 
case, it is important that you see your doctor or other health care provider 
right away to discuss your responses to these questions. He or she can help you 
determine whether you have a drinking problem and, if so, recommend the best 
course of action for you. 
Even if you answered "no" to all of the above questions, if you are encountering 
drinking-related problems with your job, relationships, health, or with the law, 
you should still seek professional help. The effects of alcohol abuse can be 
extremely serious--even fatal--both to you and to others.



The Decision To Get Help 
Acknowledging that help is needed for an alcohol problem may not be easy. But 
keep in mind that the sooner a person gets help, the better are his or her 
chances for a successful recovery. 
Any reluctance you may feel about discussing your drinking with your health care 
professional may stem from common misconceptions about alcoholism and alcoholic 
people. In our society, the myth prevails that an alcohol problem is somehow a 
sign of moral weakness. As a result, you may feel that to seek help is to admit 
some type of shameful defect in yourself. In fact, however, alcoholism is a 
disease that is no more a sign of weakness than is asthma or diabetes. Moreover, 
taking steps to identify a possible drinking problem has an enormous payoff--a 
chance for a healthier, more rewarding life. 
When you visit your health care provider, he or she will ask you a number of 
questions about your alcohol use to determine whether you are experiencing 
problems related to your drinking. Try to answer these questions as fully and 
honestly as you can. You also will be given a physical examination. If your 
health care professional concludes that you may be dependent on alcohol, he or 
she may recommend that you see a specalist in diagnosing and treating 
alcoholism. You should be involved in making referral decisions and have all 
treatment choices explained to you.



Getting Well 
Alcoholism Treatment

The nature of treatment depends on the severity of an individual's alcoholism 
and the resources that are available in his or her community. Treatment may 
include detoxification (the process of safely getting alcohol out of one's 
system); taking doctor-prescribed medications, such as disulfiram (Antabuse®) or 
naltrexone (ReViaTM), to help prevent a return to drinking once drinking has 
stopped; and individual and/or group counseling. There are promising types of 
counseling that teach recovering alcoholics to identify situations and feelings 
that trigger the urge to drink and to find new ways to cope that do not include 
alcohol use. Any of these treatments may be provided in a hospital or 
residential treatment setting or on an outpatient basis. 
Because the involvement of family members is important to the recovery process, 
many programs also offer brief marital counseling and family therapy as part of 
the treatment process. Some programs also link up individuals with vital 
community resources, such as legal assistance, job training, child care, and 
parenting classes. 
Alcoholics Anonymous 
Virtually all alcoholism treatment programs also include meetings of Alcoholics 
Anonymous (AA), which describes itself as a "worldwide fellowship of men and 
women who help each other to stay sober." While AA is generally recognized as an 
effective mutual help program for recovering alcoholics, not everyone responds 
to AA's style and message, and other recovery approaches are available. Even 
those who are helped by AA usually find that AA works best in combination with 
other elements of treatment, including counseling and medical care. 
Can Alcoholism Be Cured? 
While alcoholism is a treatable disease, a cure is not yet available. That means 
that even if an alcoholic has been sober for a long while and has regained 
health, he or she remains susceptible to relapse and must continue to avoid all 
alcoholic beverages. "Cutting down" on drinking doesn't work; cutting out 
alcohol is necessary for a successful recovery. 
However, even individuals who are determined to stay sober may suffer one or 
several "slips," or relapses, before achieving long-term sobriety. Relapses are 
very common and do not mean that a person has failed or cannot eventually 
recover from alcoholism. Keep in mind, too, that every day that a recovering 
alcoholic has stayed sober prior to a relapse is extremely valuable time, both 
to the individual and to his or her family. If a relapse occurs, it is very 
important to try to stop drinking once again and to get whatever additional 
support is needed to abstain from drinking. 
Help for Alcohol Abuse 
If your health care provider determines that you are not alcohol dependent but 
are nonetheless involved in a pattern of alcohol abuse, he or she can help you: 
Examine the benefits of stopping an unhealthy drinking pattern. 
    Set a drinking goal for yourself. Some people choose to abstain from 
    alcohol, while others prefer to limit the amount they drink. 
    Examine the situations that trigger your unhealthy drinking patterns, and 
    develop new ways of handling those situations so that you can maintain your 
    drinking goal. 
    Some individuals who have stopped drinking after experiencing alcohol-related 
problems choose to attend AA meetings for information and support, even though 
they have not been diagnosed as alcoholic. 



New Directions 
With the support of NIAAA, scientists at medical centers and universities 
throughout the country are studying alcoholism. The goal of this research is to 
develop more effective ways of treating and preventing alcohol problems. Today, 
NIAAA funds approximately 90 percent of all alcoholism research in the United 
States. Some of the more exciting investigations include: 
Genetic research: Scientists are now studying 3,000 individuals from several 
    hundred families with a history of alcoholism in order to pinpoint the 
    location of genes that influence vulnerability to alcoholism. This new 
    knowledge will help identify individuals at high risk for alcoholism and 
    also will pave the way for the development of new treatments for 
    alcohol-related problems. Other research is investigating the ways in which 
    genetic and environmental factors combine to cause alcoholism. 
    Treatment approaches: NIAAA also sponsored a study called Project MATCH, 
    which tested whether treatment outcome could be improved by matching 
    patients to three types of treatment based on particular individual 
    characteristics. This study found that all three types of treatment reduced 
    drinking markedly in the year following treatment. 
    New medications: Studies supported by NIAAA have led to the Food and Drug 
    Administration's approval of the medication naltrexone (ReViaTM) for the 
    treatment of alcoholism. When used in combination with counseling, this 
    prescription drug lessens the craving for alcohol in many people and helps 
    prevent a return to heavy drinking. Naltrexone is the first medication 
    approved in 45 years to help alcoholics stay sober after they detoxify from 
    alcohol. 
    In addition to these efforts, NIAAA is sponsoring promising research in other 
vital areas, such as fetal alcohol syndrome, alcohol's effects on the brain and 
other organs, aspects of drinkers' environments that may contribute to alcohol 
abuse and alcoholism, strategies to reduce alcohol-related problems, and new 
treatment techniques. Together, these investigations will help to prevent 
alcohol problems; identify alcohol abuse and alcoholism at earlier stages; and 
make available new, more effective treatment approaches for individuals and 
families. 



Resources 
For more information on alcohol abuse and alcoholism, contact the following 
organizations: 
Al-Anon Family Group Headquarters
    1600 Corporate Landing Parkway
    Virginia Beach, VA 23454-5617
    Internet address: http://www.al-anon.alateen.org
    Makes referrals to local Al-Anon groups, which are support groups for spouses 
and other significant adults in an alcoholic person's life. Also makes referrals 
to Alateen groups, which offer support to children of alcoholics. 
Locations of Al-Anon or Alateen meetings worldwide can be obtained by calling 
the toll-free numbers Monday through Friday, 8 a.m.-6 p.m. (e.s.t.):

U. S.: (800) 344-2666
    Canada: (800) 443-4525
    Free informational materials can be obtained by calling the toll-free numbers 
(operating 7 days a week, 24 hours per day): 

U. S.: (800) 356-9996
    Canada: (800) 714-7498
    Alcoholics Anonymous (AA) World Services
    475 Riverside Drive, 11th Floor
    New York, NY 10115
    (212) 870-3400
    Internet address: http://www.alcoholics-anonymous.org
    Makes referrals to local AA groups and provides informational materials on the 
AA program. Many cities and towns also have a local AA office listed in the 
telephone book. 
National Council on Alcoholism and Drug Dependence (NCADD)
    12 West 21st Street
    New York, NY 10010 
    (800) NCA-CALL
    Internet address: http://www.ncadd.org
    Provides phone numbers of local NCADD affiliates (who can provide information on 
local treatment resources) and educational materials on alcoholism via the above 
toll-free number. 
National Institute on Alcohol Abuse and Alcoholism
    Scientific Communications Branch
    6000 Executive Boulevard, Suite 409
    Bethesda, MD 20892-7003
    (301) 443-3860
    Internet address: http://www.niaaa.nih.gov
    Makes available free informational materials on all aspects of alcoholism, 
including the effects of drinking during pregnancy, alcohol use and the elderly, 
and help for cutting down on drinking. 
Prepared: November 1996