What Is Alcoholism?
Alcoholism is a chronic disease, progressive and often fatal; it is a primary disorder and not a symptom of other diseases or emotional problems. The chemistry of alcohol allows it to affect nearly every type of cell in the body, including those in the central nervous system. In the brain, alcohol interacts with centers responsible for pleasure and other desirable sensations. After prolonged exposure to alcohol, the brain adapts to the changes alcohol makes and becomes dependent on it. For people with alcoholism, drinking becomes the primary medium through which they can deal with people, work, and life. Alcohol dominates their thinking, emotions, and actions. The severity of this disease is influenced by factors such as genetics, psychology, culture, and response to physical pain.
Alcoholism can develop insidiously; often there is no clear line between problem drinking and alcoholism [see Box, below]. The only early indications of alcoholism may be the unpleasant physical responses to withdrawal that occur during even brief periods of abstinence. Sometimes people experience long-term depression or anxiety, insomnia, chronic pain, or personal or work stress that lead to the use of alcohol for relief, but often no extraordinary events have occurred that account for the drinking problem.
Alcoholics have little or no control over the quantity they drink or the duration or frequency of their drinking. They are preoccupied with drinking, deny their own addiction, and continue to drink even though they are aware of the dangers. Over time, some people become tolerant to the effects of drinking and require more alcohol to become intoxicated, creating the illusion that they can "hold their liquor." They have blackouts after drinking and frequent hangovers that cause them to miss work and other normal activities. Alcoholics might drink alone and start early in the day. They periodically quit drinking or switch from hard liquor to beer or wine, but these periods rarely last. Severe alcoholics often have a history of accidents, marital and work instability, and alcohol-related health problems. Episodic violent and abusive incidents involving spouses and children and a history of unexplained or frequent accidents
Who Becomes an Alcoholic?
General Risks and Age.
Some population studies indicate that in a single year, between 7.4% and 9.7% of the population are dependent on alcohol, and between 13.7% and 23.5% of Americans are alcohol-dependent at some point in their lives. A 1996 national survey reported that 11 million Americans are heavy drinkers (five or more drinks per occasion on five or more days in a month) and 32 million engaged in binge drinking (five or more drinks on one occasion) in the month previous to the survey. People with a family history of alcoholism are more likely to begin drinking before the age of 20 and to become alcoholic. But anyone who begins drinking in adolescence is at higher risk. Currently 1.9 million young people between the ages of 12 and 20 are considered heavy drinkers and 4.4 million are binge drinkers. Although alcoholism usually develops in early adulthood, the elderly are not exempt. In fact, in one study, 15% of men and 12% of women over age 60 drank more than the national standard for excess alcohol consumption. Alcohol also affects the older body differently; people who maintain the same drinking patterns as they age can easily develop alcohol dependency without realizing it. Physicians may overlook alcoholism when evaluating elderly patients, mistakenly attributing the signs of alcohol abuse to the normal effects of the aging process.
Gender.
Most alcoholics are men, but the incidence of alcoholism in women has been increasing over the past 30 years. About 9.3% of men and 1.9% of women are heavy drinkers, and 22.8% of men are binge drinkers compared to 8.7% of women. In general, young women problem drinkers follow the drinking patterns of their partners, although they tend to engage in heavier drinking during the premenstrual period. Women tend to become alcoholic later in life than men, and it is estimated that 1.8 million older women suffer from alcohol addiction. Even though heavy drinking in women usually occurs later in life, the medical problems women develop because of the disorder occur at about the same age as men, suggesting that women are more susceptible to the physical toxicity of alcohol.
Family History and Ethnicity.
The risk for alcoholism in sons of alcoholic fathers is 25%. The familial link is weaker for women, but genetic factors contribute to this disease in both genders. In one study, women with alcoholism tended to have parents who drank. Women who came from families with a history of emotional disorders, rejecting parents, or early family disruption had no higher risk for drinking than women without such backgrounds. A stable family and psychological health were not protective in people with a genetic risk. Unfortunately, there is no way to predict which members of alcoholic families are most at risk for alcoholism.
Irish and Native Americans are at increased risk for alcoholism; Jewish and Asian Americans are at decreased risk. Overall, there is no difference in alcoholic prevalence between African Americans, whites, and Hispanic people. Although the biological causes of such different risks are not known, certain people in these population groups may be at higher or lower risk because of the way they metabolize alcohol. One study of Native Americans, for instance, found that they are less sensitive to the intoxicating effects of alcohol. This confirms other studies, in which young men with alcoholic fathers exhibited fewer signs of drunkenness and had lower levels of stress hormones than those without a family history. In other words, they "held their liquor" better. Experts suggest such people may inherit a lack of those warning signals that ordinarily make people stop drinking. Many Asians, on the other hand, are less likely to become alcoholic because of a genetic factor that makes them deficient in aldehyde dehydrogenase, a chemical used by the body to metabolize ethyl alcohol. In its absence, toxic substances build up after drinking alcohol and rapidly lead to flushing, dizziness, and nausea. People with this genetic susceptibility, then, are likely to experience adverse reactions to alcohol and therefore not become alcoholic. This deficiency is not completely protective against drinking, however, particularly if there is added social pressure, such as among college fraternity members. It is important to understand that, whether it is inherited or not, people with alcoholism are still legally responsible for their actions.
Emotional Disorders.
Severely depressed or anxious people are at high risk for alcoholism, smoking, and other forms of addiction. Major depression, in fact, accompanies about one-third of all cases of alcoholism. It is more common among alcoholic women (and women in general) than men. Interestingly, one study indicated that depression in alcoholic women may cause them to drink less than nondepressed alcoholic women, while in alcoholic men, depression has the opposite effect. Depression and anxiety may play a major role in the development of alcoholism in the elderly, who are often subject to dramatic life changes, such as retirement, the loss of a spouse or friends, and medical problems. Problem drinking in these cases may be due to self-medication of the anxiety or depression. It should be noted, however, that in all adults with alcoholism these mood disorders may be actually caused by alcoholism and often abate after withdrawal from alcohol.
Alcoholism is a chronic disease, progressive and often fatal; it is a primary disorder and not a symptom of other diseases or emotional problems. The chemistry of alcohol allows it to affect nearly every type of cell in the body, including those in the central nervous system. In the brain, alcohol interacts with centers responsible for pleasure and other desirable sensations. After prolonged exposure to alcohol, the brain adapts to the changes alcohol makes and becomes dependent on it. For people with alcoholism, drinking becomes the primary medium through which they can deal with people, work, and life. Alcohol dominates their thinking, emotions, and actions. The severity of this disease is influenced by factors such as genetics, psychology, culture, and response to physical pain.
Alcoholism can develop insidiously; often there is no clear line between problem drinking and alcoholism [see Box, below]. The only early indications of alcoholism may be the unpleasant physical responses to withdrawal that occur during even brief periods of abstinence. Sometimes people experience long-term depression or anxiety, insomnia, chronic pain, or personal or work stress that lead to the use of alcohol for relief, but often no extraordinary events have occurred that account for the drinking problem.
Alcoholics have little or no control over the quantity they drink or the duration or frequency of their drinking. They are preoccupied with drinking, deny their own addiction, and continue to drink even though they are aware of the dangers. Over time, some people become tolerant to the effects of drinking and require more alcohol to become intoxicated, creating the illusion that they can "hold their liquor." They have blackouts after drinking and frequent hangovers that cause them to miss work and other normal activities. Alcoholics might drink alone and start early in the day. They periodically quit drinking or switch from hard liquor to beer or wine, but these periods rarely last. Severe alcoholics often have a history of accidents, marital and work instability, and alcohol-related health problems. Episodic violent and abusive incidents involving spouses and children and a history of unexplained or frequent accidents
Who Becomes an Alcoholic?
General Risks and Age.
Some population studies indicate that in a single year, between 7.4% and 9.7% of the population are dependent on alcohol, and between 13.7% and 23.5% of Americans are alcohol-dependent at some point in their lives. A 1996 national survey reported that 11 million Americans are heavy drinkers (five or more drinks per occasion on five or more days in a month) and 32 million engaged in binge drinking (five or more drinks on one occasion) in the month previous to the survey. People with a family history of alcoholism are more likely to begin drinking before the age of 20 and to become alcoholic. But anyone who begins drinking in adolescence is at higher risk. Currently 1.9 million young people between the ages of 12 and 20 are considered heavy drinkers and 4.4 million are binge drinkers. Although alcoholism usually develops in early adulthood, the elderly are not exempt. In fact, in one study, 15% of men and 12% of women over age 60 drank more than the national standard for excess alcohol consumption. Alcohol also affects the older body differently; people who maintain the same drinking patterns as they age can easily develop alcohol dependency without realizing it. Physicians may overlook alcoholism when evaluating elderly patients, mistakenly attributing the signs of alcohol abuse to the normal effects of the aging process.
Gender.
Most alcoholics are men, but the incidence of alcoholism in women has been increasing over the past 30 years. About 9.3% of men and 1.9% of women are heavy drinkers, and 22.8% of men are binge drinkers compared to 8.7% of women. In general, young women problem drinkers follow the drinking patterns of their partners, although they tend to engage in heavier drinking during the premenstrual period. Women tend to become alcoholic later in life than men, and it is estimated that 1.8 million older women suffer from alcohol addiction. Even though heavy drinking in women usually occurs later in life, the medical problems women develop because of the disorder occur at about the same age as men, suggesting that women are more susceptible to the physical toxicity of alcohol.
Family History and Ethnicity.
The risk for alcoholism in sons of alcoholic fathers is 25%. The familial link is weaker for women, but genetic factors contribute to this disease in both genders. In one study, women with alcoholism tended to have parents who drank. Women who came from families with a history of emotional disorders, rejecting parents, or early family disruption had no higher risk for drinking than women without such backgrounds. A stable family and psychological health were not protective in people with a genetic risk. Unfortunately, there is no way to predict which members of alcoholic families are most at risk for alcoholism.
Irish and Native Americans are at increased risk for alcoholism; Jewish and Asian Americans are at decreased risk. Overall, there is no difference in alcoholic prevalence between African Americans, whites, and Hispanic people. Although the biological causes of such different risks are not known, certain people in these population groups may be at higher or lower risk because of the way they metabolize alcohol. One study of Native Americans, for instance, found that they are less sensitive to the intoxicating effects of alcohol. This confirms other studies, in which young men with alcoholic fathers exhibited fewer signs of drunkenness and had lower levels of stress hormones than those without a family history. In other words, they "held their liquor" better. Experts suggest such people may inherit a lack of those warning signals that ordinarily make people stop drinking. Many Asians, on the other hand, are less likely to become alcoholic because of a genetic factor that makes them deficient in aldehyde dehydrogenase, a chemical used by the body to metabolize ethyl alcohol. In its absence, toxic substances build up after drinking alcohol and rapidly lead to flushing, dizziness, and nausea. People with this genetic susceptibility, then, are likely to experience adverse reactions to alcohol and therefore not become alcoholic. This deficiency is not completely protective against drinking, however, particularly if there is added social pressure, such as among college fraternity members. It is important to understand that, whether it is inherited or not, people with alcoholism are still legally responsible for their actions.
Emotional Disorders.
Severely depressed or anxious people are at high risk for alcoholism, smoking, and other forms of addiction. Major depression, in fact, accompanies about one-third of all cases of alcoholism. It is more common among alcoholic women (and women in general) than men. Interestingly, one study indicated that depression in alcoholic women may cause them to drink less than nondepressed alcoholic women, while in alcoholic men, depression has the opposite effect. Depression and anxiety may play a major role in the development of alcoholism in the elderly, who are often subject to dramatic life changes, such as retirement, the loss of a spouse or friends, and medical problems. Problem drinking in these cases may be due to self-medication of the anxiety or depression. It should be noted, however, that in all adults with alcoholism these mood disorders may be actually caused by alcoholism and often abate after withdrawal from alcohol.
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