Q #1: What do we mean by alcoholism? Alcoholism, also known as "alcohol dependence," is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law. It includes four symptoms:
- Craving--A strong need, or compulsion, to drink.
- Impaired control--The inability to limit one's drinking on any given occasion.
- Physical dependence--Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, when alcohol use is stopped after a period of heavy drinking.
- Tolerance--The need for increasing amounts of alcohol in order to feel its effects.
For clinical and research purposes, formal diagnostic criteria for alcoholism also have been developed. Such criteria are included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, published by the American Psychiatric Association, as well as in the International Classification Diseases, published by the World Health Organization. (See also "Publications", Alcohol Alert No. 30: Diagnostic Criteria for Alcohol Abuse and Dependence.)
Q #2: Is alcoholism a disease? Yes. Alcoholism is a chronic, often progressive disease with symptoms that include a strong need to drink despite negative consequences, such as serious job or health problems. Like many other diseases, it has a generally predictable course, has recognized symptoms, and is influenced by both genetic and environmental factors that are being increasingly well defined. (See also "Publications", Alcohol Alert No. 30: Diagnostic Criteria for Alcohol Abuse and Dependence.)
Q #3: Is alcoholism inherited? Alcoholism tends to run in families, and genetic factors partially explain this pattern. Currently, researchers are on the way to finding the genes that influence vulnerability to alcoholism. A person's environment, such as the influence of friends, stress levels, and the ease of obtaining alcohol, also may influence drinking and the development of alcoholism. Still other factors, such as social support, may help to protect even high-risk people from alcohol problems.
Risk, however, is not destiny. A child of an alcoholic parent will not automatically develop alcoholism. A person with no family history of alcoholism can become alcohol dependent. (See also "Publications", Alcohol Alert No. 18: The Genetics of Alcoholism.)
Q #4: Can alcoholism be cured? Not yet. Alcoholism is a treatable disease, and medication has also become available to help prevent relapse, but a cure has not yet been found. This means that even if an alcoholic has been sober for a long time and has regained health, he or she may relapse and must continue to avoid all alcoholic beverages. (See also "Publications/Pamphlets and Brochures," Alcoholism: Getting the Facts.)
Q #5: Are there any medications for alcoholism? Yes. Two different types of medications are commonly used to treat alcoholism. The first are tranquilizers called benzodiazepines (e.g., Valium®, Librium®), which are used only during the first few days of treatment to help patients safely withdraw from alcohol.
A second type of medication is used to help people remain sober. A recently approved medicine for this purpose is naltrexone (ReVia TM). When used together with counseling, this medication lessens the craving for alcohol in many people and helps prevent a return to heavy drinking. Another older medication is disulfiram (Antabuse®), which discourages drinking by causing nausea, vomiting, and other unpleasant physical reactions when alcohol is used. (See also "Press Releases", Media Advisory, Jan. 17, 1995: Naltrexone Approved for Alcoholism Treatment and "Publication", Alcohol Alert No. 33: Neuroscience Research and Medications Development.)
Q #6: Does alcoholism treatment work? Alcoholism treatment is effective in many cases. Studies show that a minority of alcoholics remain sober 1 year after treatment, while others have periods of sobriety alternating with relapses. Still others are unable to stop drinking for any length of time. Treatment outcomes for alcoholism compare favorably with outcomes for many other chronic medical conditions. The longer one abstains from alcohol, the more likely one is to remain sober. (See also "Publications", Alcohol Alert No. 17: Treatment Outcome Research.)
It is important to remember that many people relapse once or several times before achieving long-term sobriety. Relapses are common and do not mean that a person has failed or cannot eventually recover from alcoholism. If a relapse occurs, it is important to try to stop drinking again and to get whatever help is needed to abstain from alcohol. (See Question 12.) Ongoing support from family members and others can be important in recovery.
Q #7: Does a person have to be alcoholic to experience problems from alcohol? No. Even if you are not alcoholic, abusing alcohol can have negative results, such failure to meet major work, school, or family responsibilities because of drinking; alcohol-related legal trouble; automobile crashes due to drinking; and a variety of alcohol-related medical problems. Under some circumstances, problems can result from even moderate drinking--for example, when driving, during pregnancy, or when taking certain medicines. (See also "Publications", Alcohol Alert No. 30: Diagnostic Criteria for Alcohol Abuse and Dependence.)
Q #8: Are certain groups of people more likely to develop alcohol problems than others? Yes. Nearly 14 million people in the United States--1 in every 13 adults--abuse alcohol or are alcoholic. However, more men than women are alcohol dependent or experience alcohol-related problems. In addition, rates of alcohol problems are highest among young adults ages 18-29 and lowest among adults 65 years and older. Among major U.S. ethnic groups, rates of alcoholism and alcohol-related problems vary. (See also "Press Releases," Media Advisory, March 17, 1995: NIAAA Releases Estimates of Alcohol Abuse and Dependence.)
Q #9: How can you tell whether you or someone close to you has an alcohol problem? A good first step is to answer the brief questionnaire below, developed by Dr. John Ewing. (To help remember these questions, note that the first letter of a key word in each question spells "CAGE.")
Have you ever felt you should Cut down on your drinking?One "yes" answer suggests a possible alcohol problem. More than one "yes" answer means it is highly likely that a problem exists. If you think that you or someone you know might have an alcohol problem, it is important to see a doctor or other health provider right away. He or she can determine whether a drinking problem exists and, if so, suggest the best course of action.
Q #10: If I have trouble with drinking, can't I simply reduce my alcohol use without stopping altogether? That depends. If you are diagnosed as an alcoholic, the answer is "no." Studies show that nearly all alcoholics who try to merely cut down on drinking are unable to do so indefinitely. Instead, cutting out alcohol (that is, abstaining) is nearly always necessary for successful recovery. However, if you are not alcoholic but have had alcohol-related problems, you may be able to limit the amount you drink. (See Question 13 for recommended limits.) If you cannot always stay within your limit, you will need to stop drinking altogether. (See also "Pamphlets and Brochures," How to Cut Down on Your Drinking.)
Q #11: How can a person get help for an alcohol problem? You can call the Center for Substance Abuse Treatment at 1-800-662-HELP for information about treatment programs in your local community and to speak to someone about an alcohol problem.
Many people also benefit from support groups. For information on local support meetings run by Alcoholics Anonymous (AA), call your local AA chapter (check your local phone directory under "Alcoholism") or call 212-870-3400. For meetings of Al-Anon (for spouses and other significant adults in an alcoholic person's life) and Alateen (for children of alcoholics), call your local Al-Anon chapter or call the following toll-free numbers: 1-800-344-2666 (United States) or 1-800-443-4525 (Canada). (See also "Other Resources").
Q #12: If an alcoholic is unwilling to seek help, is there any way to get him or her into treatment? This can be a challenging situation. An alcoholic cannot be forced to get help except under certain circumstances, such as when a violent incident results in police being called or following a medical emergency. This doesn't mean, however, that you have to wait for a crisis to make an impact. Based on clinical experience, many alcoholism treatment specialists recommend the following steps to help an alcoholic accept treatment:
Stop all "rescue missions." Family members often try to protect an alcoholic from the results of his or her behavior by making excuses to others about his or her drinking and by getting him or her out of alcohol-related jams. It is important to stop all such rescue attempts immediately, so that the alcoholic will fully experience the harmful effects of his or her drinking--and thereby become more motivated to stop.
Time your intervention. Plan to talk with the drinker shortly after an alcohol-related problem has occurred--for example, a serious family argument in which drinking played a part or an alcohol-related accident. Also choose a time when he or she is sober, when both of you are in a calm frame of mind, and when you can speak privately.
Be specific. Tell the family member that you are concerned about his or her drinking and want to be supportive in getting help. Back up your concern with examples of the ways in which his or her drinking has caused problems for both of you, including the most recent incident.
State the consequences. Tell the family member that until he or she gets help, you will carry out consequences--not to punish the drinker, but to protect yourself from the harmful effects of the drinking. These may range from refusing to go with the person to any alcohol-related social activities to moving out of the house. Do not make any threats you are not prepared to carry out.
Be ready to help. Gather information in advance about local treatment options. If the person is willing to seek help, call immediately for an appointment with a treatment program counselor. Offer to go with the family member on the first visit to a treatment program and/or AA meeting.
Call on a friend. If the family member still refuses to get help, ask a friend to talk with him or her, using the steps described above. A friend who is a recovering alcoholic may be particularly persuasive, but any caring, nonjudgmental friend may be able to make a difference. The intervention of more than one person, more than one time, is often necessary to persuade an alcoholic person to seek help.
Find strength in numbers. With the help of a professional therapist, some families join with other relatives and friends to confront an alcoholic as a group. While this approach may be effective, it should only be attempted under the guidance of a therapist who is experienced in this kind of group intervention.
Get support. Whether or not the alcoholic family member seeks help, you may benefit from the encouragement and support of other people in your situation. Support groups offered in most communities include Al-Anon, which holds regular meetings for spouses and other significant adults in an alcoholic's life, and Alateen, for children of alcoholics. These groups help family members understand that they are not responsible for an alcoholic's drinking and that they need to take steps to take care of themselves, regardless of whether the alcoholic family member chooses to get help.
For meeting locations, call your local Al-Anon chapter (check your local phone book under "Alcoholism") or call the following toll-free numbers: 1-800-344-2666 (United States) or 1-800-443-4525 (Canada). (See also "Other Resources" Treatment Referral Information.)
Q #13: What is a safe level of drinking? Most adults can drink moderate amounts of alcohol--up to two drinks per day for men and one drink per day for women and older people--and avoid alcohol-related problems. (One drink equals one 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits.)
However, certain people should not drink at all. They include women who are pregnant or trying to become pregnant; people who plan to drive or engage in other activities requiring alertness and skill; people taking certain medications, including certain over-the-counter medicines; people with medical conditions that can be worsened by drinking; recovering alcoholics; and people under the age of 21. (See also Alcohol Alert No. 16: Moderate Drinking; Alcohol Alert No. 13: Fetal Alcohol Syndrome; and Alcohol Alert No. 27: Alcohol-Medication Interactions.)
Q #14: Is it safe to drink during pregnancy? No. Drinking during pregnancy can have a number of harmful effects on the newborn, ranging from mental retardation, organ abnormalities, and hyperactivity to learning and behavioral problems. Moreover, many of these disorders last into adulthood. While we don't yet know exactly how much alcohol is required to cause these problems, we do know that they are 100-percent preventable if a woman does not drink at all during pregnancy. Therefore, for women who are pregnant or are trying to become pregnant, the safest course is to abstain from alcohol. (See also "Publications" Alcohol Alert No. 13: Fetal Alcohol Syndrome and "Pamphlets and Brochures," Drinking and Your Pregnancy.)
Q #15: As people get older, does alcohol affect their bodies differently? Yes. As a person ages, certain mental and physical functions tend to decline, including vision, hearing, and reaction time. Moreover, other physical changes associated with aging can make older people feel "high" after drinking fairly small amounts of alcohol. These combined factors make older people more likely to have alcohol-related falls, automobile crashes, and other kinds of accidents.
In addition, older people tend to take more medicines than younger persons, and mixing alcohol with many over-the-counter and prescription drugs can be dangerous, even fatal. (See Question 18.) Further, many medical conditions common to older people, including high blood pressure and ulcers, can be worsened by drinking. Even if there is no medical reason to avoid alcohol, older men and women should limit their intake to one drink per day. (See also "Publications/Pamphlets and Brochures" Age Page: Aging and Alcohol Abuse and Alcohol Alert No. 2: Alcohol and Aging.)
Q #16: Does alcohol affect a woman's body differently from a man's body? Yes. Women become more intoxicated than men after drinking the same amount of alcohol, even when differences in body weight are taken into account. This is because women's bodies have proportionately less water than men's bodies. Because alcohol mixes with body water, a given amount of alcohol becomes more highly concentrated in a woman's body than in a man's. That is why the recommended drinking limit for women is lower than for men. (See Question 13 for recommended limits.)
In addition, chronic alcohol abuse takes a heavier physical toll on women than on men. Alcohol dependence and related medical problems, such as brain and liver damage, progress more rapidly in women than in men. (See also "Publications", Alcohol Alert No. 10: Alcohol and Women.)
Q #17: I have heard that alcohol is good for your heart. Is this true? Several studies have reported that moderate drinkers--those who have one or two drinks per day--are less likely to develop heart disease than people who do not drink any alcohol or who drink larger amounts. Small amounts of alcohol may help protect against coronary heart disease by raising levels of "good" HDL cholesterol and by reducing the risk of blood clots in the coronary arteries.
If you are a nondrinker, you should not start drinking only to benefit your heart. Protection against coronary heart disease may be obtained through regular physical activity and a low-fat diet. And if you are pregnant, planning to become pregnant, have been diagnosed as alcoholic, or have any medical condition that could make alcohol use harmful, you should not drink.
Even for those who can drink safely and choose to do so, moderation is the key. Heavy drinking can actually increase the risk of heart failure, stroke, and high blood pressure, as well as cause many other medical problems, such as liver cirrhosis. (See also "Publications", Alcohol Alert No. 16: Moderate Drinking.)
Q #18: If I am taking over-the-counter or prescription medication, do I have to stop drinking? Possibly. More than 100 medications interact with alcohol, leading to increased risk of illness, injury and, in some cases, death. The effects of alcohol are increased by medicines that slow down the central nervous system, such as sleeping pills, antihistamines, antidepressants, antianxiety drugs, and some painkillers. In addition, medicines for certain disorders, including diabetes and heart disease, can be dangerous if used with alcohol. If you are taking any over-the-counter or prescription medications, ask your doctor or pharmacist whether you can safely drink alcohol. (See also "Publications", Alcohol Alert No. 27: Alcohol-Medication Interactions.)
