Alcoholism refers to the drinking of alcoholic beverages to such a degree that major aspects of an individual’s life–such as work, school, family relationships, or personal safety and health–are seriously and repeatedly interfered with. Alcoholism is considered a disease, meaning that it follows a characteristic course with known physical, psychological, and social symptoms. The alcoholic continues to consume alcohol despite the destructive consequences. Alcoholism is serious, progressive, and irreversible. If not treated, it can be fatal.
It is generally thought that once the disease has developed, the alcoholic will not drink normally again. An alcoholic who abstains from drinking, however, can regain control over the aspects of life with which alcohol interfered. The alcoholic is then said to be “recovering,” not “cured” of the disease. It is important to note that the particular symptoms and pattern of drinking problems may vary with the individual. Alcoholism is, therefore, a very complex disorder, and this complexity has led some recent researchers to question the accuracy of the disease concept of alcoholism.
A person does not have to drink every day to be an alcoholic. Moreover, someone who drinks frequently or sometimes gets drunk is not necessarily an alcoholic. It is possible to abuse alcohol for a short or contained period of time without developing alcoholism. For example, some people may drink abusively during a personal crisis and then resume normal drinking. College students tend to drink more heavily than other age groups. It is often difficult to distinguish such heavy and abusive drinking from the early stages of alcoholism.
How well the person can tolerate giving up alcohol for an extended time, and the effect of the drinking on family, friends, work, and health, may indicate the extent of the alcohol problem. More than 10 million Americans are estimated to be alcoholic. Alcoholism is found among all age, sociocultural, and economic groups. An estimated 75 percent of alcoholics are male, 25 percent female. Alcoholism is a worldwide phenomenon, but it is most widespread in France, Ireland, Poland, Scandinavia, the United States, and the USSR.
Symptoms and Causes Some common signs of alcoholism in the early stages are constant drinking for relief of personal problems, an increase in a person’s tolerance for alcohol, onset of memory lapses while drinking (“blackouts”), surreptitious drinking, and an urgent need for the first drink (“craving”). In the middle and late phases, dependence on drinking increases and memory blackouts become more frequent. A physical dependence on alcohol first appears with early morning tremors and agitation that require a drink for relief. In the late stage, drinking bouts are usually very frequent.
There is an acute withdrawal syndrome (delirium tremens, or DTs) when drinking ceases. This includes agitation, tremor, hallucination, and possibly seizures. Most likely, a combination of biological, psychological, and cultural factors contribute to the development of alcoholism in any individual. Alcoholism often seems to run in families. Although there is no conclusive indication of how the alcoholism of family members is associated, studies show that 50 to 80 percent of all alcoholics have had a close alcoholic relative. Some researchers therefore suggest that some alcoholics have an inherited physical predisposition to alcohol addiction.
Studies of animals and of human twins lend support to the theory. A 1990 report also indicated that susceptibility to at least one form of alcoholism may be linked in part to the presence of a particular gene on chromosome 11. The gene is apparently involved with the production of receptor sites, on BRAIN cells, of the NEUROTRANSMITTER dopamine. Alcoholism can also be related to underlying emotional problems. For example, alcoholism is sometimes associated with a family history of manic-depressive illness, and some alcoholics have been known to use alcohol unwittingly to “medicate” a biological depressive order.
In addition, like so many other drug abusers, alcoholics often tend to drown depressed or anxious feelings by drinking. Conversely, some drink to reduce strong inhibitions or guilt about expressing negative feelings. Psychologists variously suggest that alcoholics have conflicts about dependency, sex roles, and family roles. It is important to note that while many alcoholics share experiences of loneliness, frustration, or anxiety, no one has identified a single personality type that will become alcoholic.
Social and cultural factors may play a role in establishing drinking patterns and alcoholism. Among some cultures there is conflict between values of abstinence and the acceptance of alcohol as a usual way to change moods or to be sociable. These conflicts within the culture may make it difficult for some people to develop their own stable attitudes and moderate patterns of drinking. Social Effects of Alcoholism The effects of alcoholism range from the direct physiological impact on the individual to a widespread effect on society.
In the United States, one family in three is estimated to be affected in some way by a drinking problem. Children of alcoholics may be affected by a father’s or mother’s alcoholism in several ways. Having a problem-drinking parent increases the risk of becoming a problem drinker oneself. This may happen because of identification with or imitation of the alcoholic parent, but also because the social and family conditions associated with alcoholism are among those believed to contribute to the development of alcoholism.
These include family conflict, divorce, job insecurity, and social stigma. Other problems reported in children of alcoholic parents in the United States and in Europe include speech disorders, hyperactivity, psychosomatic complaints, school problems, antisocial behavior, and drug use. The type of problem varies with the age and sex of the child. While having an alcoholic parent may increase the child’s risk of developing emotional or drinking problems later in life, it by no means makes becoming an alcoholic inevitable for the child.
In fact, some surveys of large communities suggest that two-thirds of adults whose parents were very heavy drinkers drink lightly themselves and have thus turned away from their parents’ drinking style. Alcoholism is an enormous public health problem. The Institute of Medicine of the National Academy of Sciences estimates that alcoholism and alcohol abuse in the United States cost society from $40 to $60 billion annually, due to lost production, health and medical care, motor vehicle accidents, violent crime, and social programs that respond to alcohol problems.
One-half of all traffic fatalities and one-third of all traffic injuries are related to the abuse of alcohol. Also, one-third of all suicides and one-third of all mental health disorders are estimated to be associated with serious alcohol abuse. Accidents and suicides associated with alcohol problems are especially prominent among teenagers. It has been estimated that there are over 3 million problem drinkers between the ages of 14 and 17 in the United States.
Treatment Alcoholism is a complex disorder for which a combination of treatments may be necessary for recovery. If the alcoholic is in the acute phase of alcoholism and is suffering from complications such as delirium tremens or serious health problems, hospitalization may be necessary. Because alcoholism is a chronic condition, however, hospitalization is only a first step toward recovery. Many alcoholics go through several brief hospitalizations for detoxification before they commit themselves to a program of recovery.
A comprehensive treatment plan can incorporate various types of facilities, including hospitals, out-patient clinics, half-way houses, individual or group psychotherapists, social centers, religious organizations, foster homes, and self-help groups. Some large corporations sponsor treatment programs for employees. An assessment of the patient’s medical, emotional, and social needs is important in making the proper referral. Not every type of facility is available in every community, but every community probably has access to a state- or city-wide system that provides for alcoholics and can help make appropriate referrals.
No one can make an alcoholic commit himself or herself to recovery. Some therapists suggest, however, that family members may influence the alcoholic by not supporting drinking activities, by seeking therapy for themselves, and by not joining in the alcoholic’s denial of the problem. Because alcoholism is sometimes thought of as a family disease, the involvement of family members can aid the progress of the alcoholic’s recovery. For the approximately 70 percent of alcoholics in the United States who remain married, living with families, and employed, the prognosis with treatment is good.
For the fewer than 5 percent who fit the stereotype of the homeless, jobless, skid-row drunk, alcohol worsens the deterioration of family, economic, and social resources. Perhaps a minute percentage of alcoholics can return to moderate drinking. But no one knows how to identify these few out of some 10 million American alcoholics. For the overwhelming majority, abstinence from alcohol is the one real hope of returning to a normal life. Once drinking has ceased, the alcoholic is free to cope with the psychological, family, social, legal, and medical problems that may be associated with alcoholism.