Alcohol abuse

Alcohol abuse is the second most common form of substance abuse in the United States, after tobacco addiction. Some people are more severely affected than others.

When an individual's drinking causes distress or harm, that's called an alcohol use disorder. An estimated 10% of adult men and 5% of adult women have an alcohol use disorder.  Their use of alcohol leads to health problems or troubles at home, at work, at school, or with the law. Many of them have lost control of their drinking; they are unable to stop or cut down despite serious negative health consequences and the loss of valued activities or relationships.

Why some people abuse alcohol and others don't is not fully understood, but a family history of addiction to alcohol places a person at higher risk. Children of parents who have trouble with alcohol have a fourfold increased risk of the disorder.

Heavy drinking can seriously damage the liver, stomach, heart, brain, and nervous system. It also increases the risk of cancer of the mouth, throat, larynx (voice box), and esophagus. Women who drink heavily are at higher risk of developing breast cancer and osteoporosis. In addition, people who drink heavily may not eat adequately, so they may develop vitamin and mineral deficiencies.

Although there are many risks to drinking alcohol, there also may be some benefits of moderate drinking. That means no more than two drinks a day for men and no more than one drink a day for women. (A drink is defined as 5 ounces of wine, 12 ounces of beer, or 1½ ounces of 80-proof distilled spirits.) Moderate drinking appears to lower the risk of heart disease, stroke, and other circulatory diseases. There is evidence that a small amount of alcohol can boost levels of high-density lipoprotein (HDL), the beneficial cholesterol in your blood, as well as reduce the formation of plaque in blood vessels.

If too much alcohol is harmful but some is beneficial, how do you decide how much is okay? First, if you don't drink, don't start. The risks that come with drinking alcohol frequently outweigh the benefits. If you drink, do so in moderation—no more than one drink a day for women and no more than two drinks a day for men.

People who should not drink include women who are trying to conceive or who are pregnant, people who plan to drive or operate equipment that requires attention or skill, and people using prescription or over-the-counter medicines that can cause drowsiness.

Alcohol can also alter the effectiveness and toxicity of medicines. Some medicines increase blood levels of alcohol or increase the adverse effects of alcohol on the brain.

Signs of alcohol abuse

An alcohol abuse disorder is a serious and progressive condition. But it is treatable. If you think you or someone you care about has a problem with alcohol, learn more about the disease and ask your doctor for help.

Early symptoms of an alcohol abuse disorder include drinking more than planned, continuing to drink alcohol despite the concerns of others, and frequent attempts to cut down or quit drinking. As alcohol abuse progresses, the individual develops a tolerance to alcohol. He or she must drink more alcohol to get the desired good feeling or to get intoxicated.

When a person becomes dependent on alcohol, and can't get a drink, he or she develops withdrawal symptoms such as headache, nausea and vomiting, anxiety, and fatigue.

As alcohol abuse worsens, the person becomes preoccupied with alcohol and can lose control. He or she may have blackouts, which are episodes in which a person completely forgets what occurred when he or she was drunk even though he or she was conscious at the time.

Finally, personality changes occur. Someone suffering from alcohol abuse can become more aggressive and his or her ability to function (hold a job or maintain relationships with friends and family) can seriously deteriorate. Heavy drinkers may experience tremors, panic attacks, confusion, hallucinations, and seizures.

People with alcohol problems often drink alone and say they use alcohol to help them sleep or deal with stress. People who drink excessively may also engage in risky sexual behavior or drive when they should not. They are also at higher risk for dependency on other drugs.

How alcohol abuse affects the body

The effects of too much alcohol on the body are devastating. Health consequences of heavy alcohol use include inflammation of the stomach, inflammation of the liver, bleeding in the stomach and esophagus, impotence, permanent nerve and brain damage (numbness or tingling sensations, imbalance, inability to coordinate movements, forgetfulness, blackouts, or problems with short-term memory), and inflammation of the pancreas. Long-term overuse of alcohol can also increase the risk and severity of pneumonia and tuberculosis; damage the heart, leading to heart failure; and cause cirrhosis of the liver, leading to liver failure.

Treating alcohol abuse

A person who needs help for alcohol addiction may be the last to realize he or she has a problem. Even if the addicted person refuses treatment, family members can get help and support from an organization like Al Anon.

Many similar drug and alcohol rehabilitation programs offer counseling to family members, so that they can learn how to help the addicted person get the right kind of support and help. An important part of these programs is to make the drinker responsible for his or her behavior, and to help the family stop shielding the drinker from the consequences of drinking.

Treating alcohol abuse begins by helping the drinker understand that he or she has a problem and needs help. Once a drinker wants to stop, treatment can take place in an outpatient setting (such as regular appointments with a counselor) or in a hospital inpatient program (where the treatment is much more intensive).

Almost all treatment programs view alcohol dependence as a chronic, progressive disease, and most programs insist on complete abstinence from alcohol and other drugs.

Inpatient treatment usually begins with detoxification—supervised withdrawal from alcohol—usually with the help of medicine to ease the dangerous effects of withdrawal, including restlessness, agitation, hallucinations, delirium, and seizures. In its most severe form, alcohol withdrawal can be life-threatening.

Treatment for alcoholism also addresses the medical and psychological consequences of alcohol addiction. Health professionals counsel the person and family about the nature of addiction and help the person find positive alternatives to using alcohol. Health professionals also help the individual cope with any related problems, such as depression, job stress, legal consequences of drinking, or troubled personal relationships.

Maintaining sobriety—often called recovery—is a long-term process that can take many forms. Fellowship groups such as Alcoholics Anonymous are often very helpful.

Ongoing counseling and treatment with medicines can also play a role. Disulfiram (Antabuse) may be an option for people who want to try a drug to help prevent them from drinking. Disulfiram disrupts the breakdown of alcohol in the liver, making a person feel ill if he or she drinks alcohol.

Another drug, called naltrexone (Revia, Vivitrol), takes away the pleasant feeling that comes with drinking alcohol, so there is less interest in drinking. A third drug, acamprosate (Campral), reduces the unpleasant feeling that alcoholics experience when they don't drink.