Criteria Marking Alcohol Dependency
A wide range of treatment programs are available to persons who are dependent on
or who otherwise abuse alcohol; however, many problem drinkers deny that they have
a problem or simply refuse to obtain help. A person who meets two or more of the
following criteria is considered to have an alcohol use disorder: drinks more or
longer than one intends; unable to stop or cut down on alcohol consumption; needs
more alcohol to get the same effect (tolerance); has withdrawal symptoms when less or no alcohol is consumed;
spends a lot of time drinking or recovering from drinking; cuts back on or gives
up activities that were once interesting, important, or pleasurable because of
drinking; continues to drink despite negative consequences with family or friends;
has problems at school or work due to drinking; craves alcohol; continues to drink
even though drinking causes anxiety or depression or exacerbates another health
problem; or gets into dangerous situations while or after drinking. According to
the National Institute on Alcohol Abuse and Alcoholism, approximately 7 percent of
Americans currently meet these criteria, and more than 10 percent meet these
criteria at some time in their lives.
Problem Recognition
Many people with alcohol use disorder deny that they have a problem; thus,
treatment is initiated by a triggering event or by the urging of another person. A
triggering event may be a conviction for drunk
driving, a serious health condition (such as pancreatitis
or cirrhosis of the liver), or a threat of divorce, job loss,
or loss of child custody. A spouse, relative, coworker, or boss may be influential
in initiating treatment. However, some alcohol abusers ignore a triggering event
or advice from others and sink deeper into alcohol abuse. For example, some women
stop drinking if they become pregnant, but some do not, even knowing that their
drinking will
harm the developing fetus.
Treatment Options
A number of treatment options are available to problem drinkers; these options vary by individual circumstances. In some cases, a brief intervention by a health care professional may be sufficient. Other cases require enrollment in an outpatient program, which includes counseling. More severe cases require an inpatient program. For some alcohol abusers who are not dependent upon alcohol, cutting back on alcohol consumption may be possible and may allow the person to return to a normal lifestyle. Persons with alcohol dependence, as most health care professionals and support groups recommend, should completely abstain from alcohol. However, some experts advocate continued moderate alcohol intake. Despite this alternative therapy, the preponderance of evidence supports complete abstinence.
Often, alcoholics abuse other substances, such as cocaine, marijuana, and
prescription drugs, so treatment programs also should include therapy for
addiction to these substances. Tobacco contains nicotine, which is highly addictive. Some treatment programs
include smoking
cessation in their programs, while others focus on the abuse
of alcohol and other substances, excluding tobacco.
The following steps are involved in treating alcohol abuse and alcoholism:
Detoxification
. For persons
with alcohol dependency, detoxification (or detox) is necessary. Sedatives are
often necessary to reduce withdrawal symptoms, which include shaking, confusion,
hallucinations, or even seizures in severe cases. Collectively, these symptoms are
termed delirium tremens (DTs). Withdrawal may require up to one
week and usually requires inpatient care at a hospital or a treatment center.
Reprogramming. With the help of health care professionals skilled
in alcohol abuse treatment, one can learn new life and coping skills and can
formulate a treatment plan. The plan should include behavior modification
techniques, counseling, goal-setting, and the use of self-help manuals and web
resources.
Psychological counseling. Counseling on an individual or group
basis is an essential treatment component. Group therapy is particularly valuable
because it allows interaction with other alcohol abusers, and it increases the
awareness that one’s problems are not unique. Therapy may include the presence of
a spouse or other family members. Family support is a significant component of the
recovery process.
Medication. Following medication for detox, long-term pharmaceutical treatment may be used. Oral medications available for treatment include disulferam, acamprosate, and naltrexone. Disulferam (Antabuse), which is taken by mouth, produces unpleasant physical reactions when taken in combination with alcohol, such as flushing, headaches, nausea, and vomiting. Disulferam does not reduce the craving for alcohol; however, acamprosate (Campral) may reduce alcohol craving. Naltrexone
(ReVia) also may reduce the urge to drink; furthermore, it blocks the pleasant sensations associated with the consumption of alcohol. One problem with oral medications is this: If a person wants to return to drinking, he or she can simply stop taking the medication.
Follow-up support. Aftercare programs and support groups are
essential if the recovering individual is to avoid (or manage) relapses and deal
with the necessary life changes to maintain sobriety. Regular attendance at a
support group such as Alcoholics
Anonymous (AA) is often a component of follow-up care.
Follow-up often includes psychological and medical care. Alcoholism commonly
co-occurs with other mental health disorders. For these cases, psychological
counseling or psychotherapy may be recommended. Treatment for depression or
anxiety also may be a part of follow-up.
Alcoholics commonly have medical conditions that require treatment. These
conditions include hypertension (high blood pressure), diabetes, heart disease,
and liver disease (cirrhosis of the liver). Some medical conditions may decrease
in severity or resolve with sobriety.
Beyond counseling and medication, other modalities may be helpful. For example, in
2010, researchers released the results of a clinical trial on a unique new therapy
that applies electrical stimulation to a major nerve emanating from the brain. The
technique, trigeminal nerve stimulation, achieved an average of a 70 percent
reduction in symptom severity in an eight-week study period.
Inpatient Treatment
For persons with a serious alcohol abuse problem, inpatient care is often necessary. These programs include detox followed by counseling, group therapy, and medical treatment. A benefit of an inpatient program is that it greatly reduces the risk of a patient gaining access to alcohol or other harmful substances. For anyone who receives inpatient care, regular outpatient follow-up is essential.
Many medical centers include treatment for substance abuse, including alcohol.
Stand-alone facilities also can be found throughout the United States and other
nations. Some provide care in a basic, clinical setting while others function in a
resort-like setting. One well-known facility is the Betty Ford
Center (in Rancho Mirage, California), which was founded by
former US first lady Betty Ford. The one-hundred-bed nonprofit residential
facility offers inpatient, outpatient, and day treatment for alcohol use disorder
and other substance abuse problems. It also provides prevention and education
programs for family members (including children) of substance abusers.
Support Groups
Many support groups are available to those who admit they have a problem and who
want a life without dependence upon alcohol. Treatment centers may have their own
support groups or may refer patients to outside programs. A recovering individual
may have to try many different resources before finding the best fit.
Alcoholics Anonymous. The primary goal of the well-known
international support group AA is to help individuals with alcohol use disorder
stay sober. AA was founded in 1935 by Bill Wilson, a New York stock broker, and
Bob Smith, an Ohio surgeon, in Akron, Ohio. Both had been “hopeless drunks.” The
organization claims more than two million members. New members are encouraged to
avoid drinking but to do so “one day at a time” instead of “swearing off [alcohol]
forever.”
AA is established in more than one hundred nations; members in each group usually
meet once or twice a week. Two main types of meeting are held: open and closed. In
open meetings, speakers describe how they drank, how they discovered AA, and how
AA has helped them. Relatives, friends of members, and anyone interested in the
organization may attend. Closed meetings, which are for alcoholics only, consist
of group discussions involving questions, shared thoughts, and discussions of
personal problems.
AA has no formal government; the membership elects a chairperson, a secretary, and other group officers. The sole function of these persons is to ensure that the meetings run smoothly. No membership dues are assessed. The organization pays for expenses from donations.
Al-Anon and Alateen. Al-Anon (which includes Alateen for younger
members) is a support group for friends and families of problem drinkers. The
organization estimates that each alcoholic usually impacts the lives of a minimum
of four other persons; thus, alcoholism is a family disease. Al-Anon and Alateen
are open to affected persons whether or not the alcoholic in their lives is still
drinking. Al-Anon and Alateen report more than 24,500 groups meeting in 135
countries. The meetings are anonymous and confidential; no dues or fees are
required for membership.
Religious Support
Churches and synagogues often sponsor support for alcoholics. Members can avail
themselves of services, which are often integrated with other organizations and
social services in the community. Sometimes, a person who has no religious faith
can get help by first accepting a religious faith. Although nonsectarian and
nondenominational, AA, for example, is a faith-based organization as exemplified
by its twelve-step program, which, in part, acknowledges the existence of a
supreme being.
Genetic Factors
Significant evidence exists that genetic factors play a part in whether or not a
person develops an alcohol use disorder. The interaction of genes and
environmental factors that influence alcohol dependence is a complex scientific
topic. For most people with alcohol dependence, many factors are involved.
Since 1989, the US-government-funded Collaborative Studies on the Genetics of
Alcoholism (COGA) has been tracking alcohol use disorders in families. COGA
researchers have interviewed more than 14,000 people and have sampled the DNA
(deoxyribonucleic acid) of more than 300 extended families. Researchers have found
evidence for the existence of several alcohol-related genes. COGA researchers are
increasingly convinced that different types of alcohol-related problems are
representative of a number of genetic variations. Researchers are using the
accumulated data to identify drugs that can help treat an alcoholic based on his
or her specific DNA profile. Most drugs on the market for the treatment of alcohol
abuse merely reduce alcohol craving. Compliance is a problem too, and these drugs
are not effective for everyone.
Recognized genetic factors in developing alcohol use disorder include the
following: Children of alcoholics have a high risk of alcohol abuse, a
risk that is present even if the children are raised in homes without alcohol
abuse; the sons of alcoholic fathers have nine times the normal risk of becoming
alcoholics themselves; people with a certain gene become inebriated with just one
or two drinks (thus, they are often discouraged from abusing alcohol); if one
identical twin is an alcoholic, the other twin has a 76 percent risk of
alcoholism; many Asians have genes that cause them to quickly metabolize alcohol
(this causes a rapid heartbeat and nausea; thus, reducing their risk of becoming
alcoholics); a rare gene present mainly in Finnish people makes them susceptible
to severe impulsivity and alcoholism; a dopamine-receptor gene enhances pleasure
from alcohol; friends often choose friends with the same genetic variation; and
genes regulating neuropeptide Y are linked to stress and withdrawal symptoms from
alcohol.
Bibliography
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Thomas Harrison. Substance Abuse: Information for School Counselors,
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Ketcham, Katherine,
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Understanding the Alcoholic’s Mind: The Nature of Craving and How
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Miller, William R.,
and Kathleen M. Carroll, eds. Rethinking Substance Abuse: What the
Science Shows, and What We Should Do about It. New York:
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Seixas, Judith, and
Geraldine Youcha. Children of Alcoholism: A Survivor’s
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