Alcohol Abuse, Alcohol Dependence

What is Alcoholism?

Alcoholism is a chronic disorder characterized by the excessive and compulsive use of alcohol. Alcohol is a drug, a substance that affects the function (and often the judgment)of the person using it. Although alcohol is not illegal, it can still have negative effects when it is misused, and can lead to addiction. Alcoholism usually includes the following components:

  • Craving. A strong urge to drink.
  • Loss of control. The inability to limit intake or to stop drinking once started.
  • Physical dependence. After heavy drinking, symptoms of withdrawal are experienced, such as nausea, sweating, shakiness and anxiety.
  • Tolerance. The need for increasingly greater amounts of alcohol to achieve the same level of intoxication.
Alcoholism is different from alcohol abuse. Alcohol abuse is defined as drinking that results in one or more of the following consequences in a 12-month period:
  • Inability to fulfill major work, school or home responsibilities
  • Drinking in dangerous situations, such as while driving a car or operating machinery
  • Legal problems that result from drinking, such as being arrested for driving under the influence of alcohol
  • Ongoing relationship problems that worsen due to drinking
Unlike people with alcoholism, individuals who abuse alcohol do not crave alcohol or experience physical withdrawal symptoms if they do not drink. However, people who abuse alcohol can eventually develop alcoholism.

Although they do not meet the criteria for alcoholism or alcohol abuse, some people may be problem drinkers.

The following may indicate a problem with drinking alcohol:
  • Feeling the need to cut down on drinking
  • Becoming annoyed at criticism about drinking
  • Feeling bad or guilty about drinking
  • Having a drink in the morning to steady nerves or get rid of a hangover
Alcoholism depresses the central nervous system by acting as a sedative. Excessive alcohol use can result in harm to the brain and nervous system and cause fatigue, short-term memory loss and weakness and paralysis of the eye muscles. It can also cause the following health problems:
  • Liver disease. Heavy drinking can cause alcoholic hepatitis (inflammation of the liver). This can lead to cirrhosis (irreversible and progressive destruction of liver tissue).
  • Gastrointestinal problems. Alcohol can cause inflammation of the stomach lining (gastritis). It can also damage the pancreas (pancreatitis).
  • Cardiovascular problems. Heavy drinking can lead to high blood pressure (hypertension) and damage the heart (cardiomyopathy).
  • Diabetes complications. Alcohol prevents the release of glucose (blood sugar) from the liver and can cause it to fall too low (hypoglycemia). This is dangerous for people with diabetes.
  • Sexual and menstrual dysfunction. Alcohol can cause erectile dysfunction in men and can interfere with menstruation in women.
  • Birth defects. Drinking while pregnant can cause fetal alcohol syndrome. This condition results in a small head, heart defects, shortening of the eyelids and may lead to developmental disabilities in the child. Research also indicates that alcohol consumption during pregnancy may lead to behavioral problems in children.
  • Neurological problems. Heavy drinking can affect the nervous system and cause numbness of the hands and feet, disordered thinking and dementia.
  • Increased risk of cancer. Chronic drinking can increase the risk of developing cancers of the esophagus, larynx, liver and colon.
Alcoholism can also result in the following:
  • Domestic abuse
  • Divorce and impaired relationships (e.g., with friends, family members)
  • Difficulty performing at work or school
  • Financial problems
  • Motor vehicle accidents
  • Alcohol-related arrests
  • Accidental injuries that occur while or after drinking
  • Higher incidence of suicide and murder
According to the National Institute on Alcohol Abuse and Alcoholism, nearly 17.6 million adult Americans have alcoholism or abuse alcohol. Several million more exhibit risky drinking patterns that could develop into more serious problems. Also, 53 percent of Americans report that one or more of their close relatives has a drinking problem.

Risk factors and potential causes of alcoholism

Alcohol alters the balance of some chemicals in the brain, such as gamma-aminobutyric acid (GABA, a major inhibitory neurotransmitter) and glutamate (neurotransmitter involved in learning and memory). It also increases the amount of dopamine (neurotransmitter essential to thought, motivation, short-term memory and some emotions) in the brain.

Alcoholism tends to develop gradually over time as heavy drinking increases or reduces brain chemicals, which causes a person to crave alcohol to elevate their mood or to avoid negative feelings.

Some other factors that may lead to excessive drinking and alcoholism include:

  • Genetics. People with an inherited imbalance of brain chemicals may be more likely to develop alcoholism.
  • Emotions and psychological factors. People who experience high levels of stress, anxiety and/or poor self-esteem may be more apt to drink to cope with the turmoil. People with mental health disorders, such as depression, bipolar disorder and schizophrenia, are also more likely to develop alcoholism. In addition, associating with heavy drinkers may increase the likelihood of drinking or the amount of alcohol consumed.
  • Social and cultural factors. Alcohol is often portrayed in glamorous ways on television and in advertisements. This may contribute to social acceptance of heavy drinking.
Over time, heavy drinking habits can result in a dependence on alcohol. In general, men who consume more than 14 drinks a week and women who consume more than seven drinks a week have a greater risk of developing alcoholism. Other risk factors include:
  • Age. People who begin drinking early in life (age 14 or younger) are more likely to develop alcoholism.
  • Gender. Men are more likely to develop alcoholism than women.
  • Family history. People with a parent who abused alcohol are more likely to develop alcoholism.
Recent research reveals that teenage girls who mature earlier than their peers and have older boyfriends are more likely to become problem drinkers. Additionally, research indicates that there is a relationship between frequent consumption of alcohol and unhealthy eating habits.

Signs and symptoms of alcoholism

There are many signs and symptoms associated with alcoholism.

These may include:

  • Compulsion. Feeling a strong need to drink.
  • Blackouts. Periods of time after drinking that cannot be remembered.
  • Tolerance. Requiring increasingly larger amounts of alcohol to experience the same effect.
  • Physical withdrawal symptoms. These may include nausea as well as shaking, sweating, confusion and hallucinations (delirium tremens) while not drinking. Delirium tremens (also known as “the DTs”) is the most serious symptom of acute alcohol withdrawal.
  • Legal, relationship, financial problems.
  • Anhedonia. Loss of interest in once pleasurable activities.
  • Unusual drinking habits. These may include drinking alone or in secret, gulping drinks or making a ritual of having drinks before, during and after dinner.
  • Irritability. Feeling irritable when drinking patterns are disrupted.

Research also suggests that people with alcoholism may have difficulty interpreting the emotions of others.

Many people who abuse alcohol experience many of the same symptoms as those who have alcoholism. However, a main difference is that people who abuse alcohol do not experience compulsion to drink or physical withdrawal symptoms when they do not drink.

Although it tends to take years for adults to develop alcoholism, young teenagers can become addicted to alcohol more quickly.

Some signs and symptoms of problems with alcohol in teenagers include:

  • Loss of interest in activities or hobbies
  • Bloodshot eyes, slurred speech, scent of alcohol on breath or memory loss
  • Difficulties in relationships or changes in friendships
  • Declining school attendance, performance or other problems at school
  • Mood swings and defensive behavior

Many people with alcoholism also experience denial (the refusal to recognize truth or reality). This results in failure to recognize a problem with alcohol, even though signs and symptoms are present. Many people with alcoholism seek help only at the insistence of friends, family members, coworkers or others.

People are encouraged to consult a physician about alcohol use if they:

  • Feel that drinking is a problem
  • Feel guilty about drinking
  • Cannot control drinking
  • Drink shortly after waking up
  • Need increasing amounts of alcohol before feeling its effects

Diagnosis of alcoholism

Alcoholism may be determined by a physician during a physical examination that includes a medical history and list of medications. It is sometimes difficult to diagnose because many people with alcoholism also experience denial (the refusal to recognize truth or reality). This may cause people to hide aspects of drinking or to fail to recognize that physical symptoms (such as digestive problems) may be related to drinking.

Patients suspected of having alcoholism may be asked to fill out a questionnaire, such as the CAGE questionnaire. The questionnaires include questions aimed at identifying drinking patterns and emotions that indicate alcoholism.

For example, the CAGE questionnaire includes four questions. An affirmative answer to two or more questions indicates a high likelihood of alcoholism. The questions are:

  • Have you felt you should Cut down on your drinking?
  • Have people Annoyed you by criticizing your drinking?
  • Have you felt bad or Guilty about your drinking?
  • Have you ever had to drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)?
Blood alcohol tests are not usually performed because they only identify levels of alcohol ingested at a particular point in time, not long-term use. However, patients may be given other tests, such as liver function tests and other blood tests. People with alcoholism may have elevated liver function tests (which indicates liver damage) and anemia (low red blood cell count).

Patients suspected of having alcoholism may be referred to a substance abuse counselor or other health professional that specializes in treating addiction.

Treatment options for alcoholism

Because people with alcoholism often experience denial (the refusal to recognize truth or reality), they often begin treatment only at the insistence of friends, family members, coworkers or others. Sometimes, patients seek treatment after an intervention (an orchestrated attempt by family and friends to encourage a person to seek help for addiction).

Treatment techniques vary according to the severity of the alcohol problem and other factors. Treatment for people who abuse alcohol may involve cutting back on drinking. For those who are dependent upon alcohol, treatment must involve refraining from drinking (abstinence). Patients may be treated in an outpatient program or a residential inpatient program.

Components of alcoholism treatment programs may include:

  • Detoxification. Patients withdraw from alcohol, a process which usually lasts four to seven days. Medications to minimize symptoms experienced with withdrawal (such as seizures) are usually administered.
  • Medical assessment and treatment. Patients are treated for medical conditions that may be present with alcoholism, such as high blood pressure, increased blood sugar and liver and heart disease.
  • Psychological treatment. Patients with mental health disorders that contribute to alcoholism, such as depression, may receive treatment for the underlying disorder. Others receive support through group and individual counseling.
  • Medications. Some patients are treated with special drugs, designed remove the compulsion to drink, block the intoxicating effects of alcohol or help to prevent relapses in people who have stopped drinking alcohol.
Because relapse (using alcohol after a period of abstinence) is common, people with alcoholism often receive ongoing treatment. This may involve individual or group counseling or participation in a self-help group. One of the most popular self-help groups is Alcoholics Anonymous (worldwide fellowship of people with alcoholism whose primary goal is to advocate recovery and sobriety through a 12-step process). Members meet on a regular basis and share personal stories of their recovery in an attempt to provide support and foster sobriety.

Because family support is important to recovery, many programs offer marital counseling or couples therapy, family therapy or other services as part of treatment. Programs may also help patients find other types of services needed for recovery, such as legal assistance, job training, childcare and parenting classes.

Other therapies for patients with alcoholism may include:

  • Acupuncture. The insertion of thin needles under the skin. This may reduce cravings for alcohol. Acupuncture is performed by an acupuncturist.
  • Motivational enhancement therapy. Therapy aimed at helping the patient acknowledge the alcohol problem and change behavior through stages.
  • Cognitive behavior therapy. Psychotherapy that relies on the recognition of distorted thinking and replacing such thinking with more realistic ideas.
  • Couples therapy. Therapy attended by both the patient with alcoholism and their significant other. Involving a partner may increase the chance of successful treatment.
  • Aversion therapy. Involves taking a medication that causes an adverse response, such as nausea and vomiting, when alcohol is ingested.

Prevention methods for alcoholism

The best way to prevent alcoholism is to abstain from drinking alcohol. For those who drink, recognizing a family history of alcoholism is an important first step in preventing alcoholism. Also, recognizing signs and symptoms of problem drinking (such as binge drinking and drinking shortly after waking up) is important. Problem drinkers who change drinking habits may prevent the development of alcoholism in the future.

Early intervention is particularly important with teenagers because they can become addicted to alcohol more quickly than adults.

Parents can curb alcohol use in teenagers by:

  • Talking to children about alcohol, including the legal and medical consequences of drinking.
  • Setting a good example with alcohol by drinking responsibly.
  • Spending time with children, but also understanding their need for independence.
  • Establishing boundaries with children and letting them know what behaviors are accepted and not accepted.

Questions for your doctor regarding alcoholism

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following alcoholism-related questions:

What is the difference between alcoholism and alcohol abuse?

  • How can I tell if I have a problem with drinking?
  • What are the medical consequences related to drinking?
  • If one of my parents has alcoholism, does that mean I will develop it?
  • What are some of the most common signs and symptoms of alcoholism?
  • How can I tell if my teenager is drinking?
  • What is the best way for me to treat my alcoholism?
  • Should I be treated in an inpatient or outpatient facility?
  • What are some of the best ways to prevent relapse?
  • How do I go about arranging an intervention for a loved one?

Additional Information


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What might complicate it?

Alcoholism can damage virtually any organ system. The gastrointestinal tract is often first to show toxic effects such as gastritis and gastrointestinal bleeding. After years of heavy drinking, liver damage may occur (alcoholic hepatitis, cirrhosis), along with an increased risk of liver cancer. The pancreas also may be affected by chronic pancreatitis.

  • Prolonged, excessive use of alcohol is toxic to the nervous system. In addition to acute impairment of alcohol intoxication and withdrawal, brain function also may be chronically impaired; poor memory is a common finding, which may improve with abstinence. If drinking continues, however, irreversible atrophy of the brain may occur, with long-term and short-term memory impairment. Dementia may develop, with loss of higher brain functions such as judgment, abstract thinking, language, etc.
  • Personality changes may be seen, and sometimes a psychosis develops. Other parts of the brain may be damaged as well, resulting in disturbances of balance and coordination.
  • Prolonged heavy drinking can also be toxic to nerves, resulting in a painful peripheral neuropathy.
  • Heavy drinking may result in cardiovascular disorders of high blood pressure, abnormal heart rhythms (arrhythmias), and damage to heart muscle (cardiomyopathy).
  • Excessive alcohol intake can lead to anemia. It may alter hormone levels, interfere with blood clotting, impair immunity, and result in nutritional deficiencies.
  • There are often disastrous psychosocial consequences, such as loss of relationships and employment. Accidents, violence, and suicide can be consequences of alcoholism.
  • Heavy drinking during pregnancy can result in fetal alcohol syndrome.

Predicted outcome

A high percentage of alcoholics will relapse, regardless of the type of treatment, and usually within six months. This does not mean that treatment has failed, but rather that it must be ongoing. Relapses may occur a number of times, but eventually the cycle may stop as the individual restructures his or her life, replacing alcohol with other sources of gratification. The earlier in the course of alcoholism the treatment is begun, the better the prognosis.


Another cause of altered mental state can be diabetic ketoacidosis, in which the breath has a fruity odor of acetone, which sometimes is confused with alcohol; low blood sugar can also have a disturbed mental state. Alcoholism often is accompanied by or confused with other substance abuse.

Appropriate specialists

Psychiatrist, psychologist, gastroenterologist, cardiologist and neurologist.