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Alcohol

Risky Drinking, Alcohol Abuse, and Alcohol Dependence. How can you tell when drinking is a problem? Not everyone who drinks regularly has a drinking problem. In fact, more and more studies are showing health benefits from a moderate amount of alcohol. However, for reasons that are not entirely understood, some people may be more in danger of developing an alcohol-related disorder. If you are concerned about alcohol use, either your own, or that of someone you care about, perhaps this page can give you useful information.

 
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Drinking Patterns

There are several major patterns of problematic drinking that range on a continuum from mild to severe.

  • Risky drinking. Drinking is labeled "risky" when a person:

    • Drinks a lot at one time. Five (5) or more standard drinks in one day (for men) or four (4) or more standard drinks in one day (for women) indicate risky drinking.
    • Drinks a lot on a regular basis. More than fourteen (14) or more standard drinks per week on average (for men) or seven (7) or more standard drinks per week on average (for women) indicates risky drinking.
    • Drinks when it can damage their health or place them at risk. For a pregnant woman, or for a person taking medications that don't mix well with alcohol, drinking any amount of alcohol is risky. Similarly, for a person who must drive or operate machinery, any amount of alchohol is risky.

      A "standard" drink, as defined by the U.S. Department of Health and the U.S. Department of Health and Human Services, is:
      • A 12-ounce bottle of beer; or
      • A 5-ounce glass of wine; or
      • A 1-1/2 ounce shot of liquor.

  • Problem drinking. Problem drinkers may be drinking in "risky" patterns. What makes them "problem drinkers" is that they also are having problems in their lives because of the way they drink. For example, they may not be doing as well at work or in school because of being out late at night or having a hangover on a regular basis. Or they may be getting into arguments with their friends or family because of their drinking habits. Or perhaps while drunk they have said or done hurtful or embarrassing things that have caused problems in their relationships.

  • Alcohol abuse. A person who can be said to abuse alcohol can experience all of what a problem drinker experiences, but the person continues to drink in the face of mounting problems that become more and more serious. For example, a person abusing alcohol might be arrested for drunken driving one or more times, get fired from their job for showing up drunk or missing too much work, have their spouse leave them or their parents ask them to leave home, or have other serious problems, and continue to drink as if nothing was wrong.

  • Alcohol dependence. A person with alcohol dependence can experience all of the above problems, or, paradoxically, may have few outward problems as a result of their alcohol use. Regardless, the person with alcohol dependence has a serious disorder. To be considered dependent, a person must have three or more of the following distinctive features:

    • Tolerance. Tolerance occurs when a person needs larger amounts of alcohol to feel the same effect they used to feel with less. For example, a person used to relax with one or two beers, and now it takes four or five, or six or seven, to feel that state of relaxation they could get with one or two.
    • Withdrawal. Withdrawal means that when a person stops drinking, she or he experiences unpleasant side effects. This is why some people take a "hair of the dog" approach in the morning, or seem to always have alcohol near them. Mild withdrawal symptoms include nervousness, sweating, shakiness, and abnormally fast heartbeat. In extreme cases, the unpleasant effects of withdrawal can lead to delirium, seizures, or life threatening complications.
    • Loss of control. This can include drinking more than intended, or for a longer time (e.g., staying at the bar until closing) than intended, or more frequently than intended. Loss of control is a factor in "blackouts," when a person drinks so much that their brain's functioning is disturbed to the degree that it cannot remember what they are doing. The person later learns from others about their activities while drinking.
    • Inability to stop. Usually a person with alcohol dependence has tried to quit on several occasions but has been unsuccessful.
    • Alcohol-centered life changes. A person with dependence spends a lot of time either drinking or recovering from being drunk. Their friends and activities revolve around alcohol and they no longer are interested in non-alcoholic friendships or hobbies that used to bring them pleasure.
    • Health problems. Alcohol travels to every cell in the body. Over time, using too much alcohol can damage the heart, raise blood pressure, cause cancer, liver disease and brain damage. It can lead to ulcers, weakened muscles and even death. In addition to these problems brought on by alcohol use, alcohol can aggravate problems that are made more serious by drinking (e.g., diabetes). In spite of threats health, a person with dependence does not stop drinking.

Prevalence

The National Institute on Alcohol Abuse and Alcoholism has collected national statistics on how many adult Americans fall into each category, and what their risk is of having alcohol abuse or dependence.

Genetic and Environment Causes

It is well known that alcoholism runs in families. While genetic factors can make a person more susceptible to alcoholism, environmental factors significantly affect whether a person puts themselves in situations that can lead to abuse or dependence. Environmental factors include influence of friends, overall stress level, ease and acceptability of obtaining alcohol, presence or absence of concerned people who notice and intervene if a problem starts to gain momentum.

Research shows that:

  • Children of alcoholics have a 2 - 4 times greater risk of developing alcohol abuse or dependence than children of non-alcoholics. They are much more likely to begin drinking during adolescence.
  • People who began drinking before age 15 are 4 times more likely to develop alcohol dependence and twice as likely to abuse alcohol as peers who started drinking later in life. The younger the age of drinking onset, the greater the chance that an individual at some point in life will develop a clinically defined alcohol disorder.
  • The converse is also true: The risk for alcohol dependence and alcohol abuse DECREASE by 14% for each increasing year of age of drinking onset.
  • Caucasians have the highest rate of alcohol disorders.
  • These disorders are more common in men and men are more likely to be binge drinkers
  • Alcohol disorders are more prevalent in metropolitan areas.
  • Alcohol disorders are more common in the more highly educated.

Couples and Family Problems

If you are close to someone with an alcohol problem you probably feel a host of mixed emotions: fear that the person will continue drinking and that the negative consequences of the drinking will worsen; anger over the way your life is changed because of the person's drinking; sadness over missed opportunities to be with the person because they seem more interested in drinking than in any other activities.

In fact, couples can suffer loss of intimacy, frequent and serious conflict, violence, infidelity, and ongoing money problems as a result of alcohol use in one or both partners.

It can be difficult to know what to do if you are in a relationship with an alcoholic because in between the "bad" times, life can be great. The alcoholic may seem to be changing the drinking patterns that are causing the trouble. But just when you start to relax, the problems crop up again and you are back to disappointment, fear, anger, sadness, and the other negative consequences of alcoholism.

Even though you may want to be helpful to the alcoholic, covering up, or preventing the negative consequences of his or her problem, only serves to help the person maintain denial and consequently continue with alcohol problems, which get worse if untreated. While intentions are usually very caring, outcomes are negative with this process. Don't ignore and/or cover up the problem--take action.

Approaching the Drinker

It can be difficult to approach a loved one whose drinking is cause for concern. Talking over your concerns with a professional first can help you sort out your feelings and clarify your message to the person so that the discussion goes well. It's important to be ready for a negative reaction on the part of the drinker, who may be in denial about the severity of the problems or their impact on you.

When you do approach the person, try to get him or her to agree to some form of positive action. Ask them to attend a single therapy session with you to get another opinion about the situation. Be positive and non-blaming in your approach. Do what you can, but remember the "Three Cs".

  • You did not CAUSE the other person's problem;
  • You can not CONTROL the other person; and
  • You cannot CURE the other person.

Treatment Options

There are many treatment options available for people struggling with alcohol and those who care about them.

For the drinker, the choice of treatment depends in large part on the severity of the alcohol problem as well as other factors in the his or her situation. While no single treatment has yet been found to be the definitive treatment for alcohol problems, cognitive-behavioral therapy and twelve-step groups have been found to be of benefit. A thorough assessment is the first step in choosing the best treatment for a specific individual.

  • Cognitive-behavioral therapy for alcohol problems focuses on educating people about alcoholism, helping them learn what triggers them to drink, teaching them new coping strategies so they are less dependent on alcohol as short-term emotional relife, and helping them avoid relapse.
  • For many people, the 12-step approach, as used in Alcoholics Anonymous, is helpful. The drinker proceeds through the lessons and growth promoted by each step, while staying sober. Group support is a major component of the 12-step program, so that the drinker has access to many people who have come through sobriety who can offer support, encouragement, and fellowship.
  • Family and couples therapy has been found to be of assistance as a part of a treatment plan for alcohol problems. A combination of individual (cognitive-behavioral) therapy, to help the person who is having alcohol problems develop and follow a recovery plan, and couples or family therapy, to help the partner or other family members develop effective strategies for assisting with recovery, is a powerful strategy. Therapy also can help all family members heal from the hurt caused by the alcoholism, foster appropriate trust and hope, and rebuild relationships.
  • Self-help groups are an important part of a recovery plan for both alcoholics and those who care about them. Some of the most common self-help groups in the Washington, D.C. area that help people with alcohol-related issues are listed below.
    • Alcoholics Anonymous (AA) describes itself as a “worldwide fellowship of men and women who help each other to stay sober.” It is an effective, mutual help program for recovering alcoholics. There are free meetings several times a day, every day, in most parts of the country. The Washington / Maryland / Virginia area has dozens of meetings every day, mornings, afternoons, and evenings. The phone number for AA can be obtained from Directory Assistance, in the yellow pages, or on the worldwide web at http://www.alcoholics-anonymous.org. A 24-hour number for Alcoholics Anonymous world headquarters in New York is 212-870-3400; people there can direct you to local information.
    • SMART Recovery states that its purpose is “to support individuals who have chosen to abstain, or are considering abstinence from any type of addictive behavior (substances or activities), by teaching how to change self-defeating thinking, emotions, and actions; and to work towards long-term satisfactions and quality of life.” SMART stands for “Self Management And Recovery Training” and the groups emphasize personal choice and responsibility, not genetic or "disease" explanations of addiction. The program targets four areas that can help people build stronger lives: (1) Enhancing and maintaining motivation to abstain; (2) Coping with urges; (3) Problem solving (managing thoughts, feelings and behaviors); (4) Lifestyle balance (balancing momentary and enduring satisfactions). As with AA, participation in SMART is free, voluntary, and confidential. SMART groups occur around the country, with several groups in the Washington / Maryland / Virginia area. To find out more about SMART, check the national website at http://www.smartrecovery.org/, and the Washington metro area website at http://www.his.com/~washdcsmart/. The national office contact information is 440.951.5357 or srmail1@aol.com, but the office responds during business hours only.

Detoxification

People who have high blood alcohol levels may need detoxification before they can become sober and get treatment. Detoxification is a supervised period in which a person withdraws from alcohol. In severe cases or if there are complicating medical conditions, detoxification may need to occur in a hospital setting and/or with the aid of medications. In milder cases, it is possible that detoxification may safely take place in a chemical dependency treatment facility or, if the person has adequate family support and supervision, at home. A thorough assessment is needed to determine the most appropriate plan for detoxification.

If your concern is about a loved one, there are treatment options to help you, as well.

  • Family and couples therapy has been found to be of assistance as a part of a treatment plan for alcohol problems. A combination of individual (cognitive-behavioral) therapy, to help the person who is having alcohol problems develop and follow a recovery plan, and couples or family therapy, to help the partner or other family members develop effective strategies for assisting with recovery, is a powerful strategy. Therapy also can help all family members heal from the hurt caused by the alcoholism, foster appropriate trust and hope, and rebuild relationships.
    • Alanon offers help and support to family members and friends of people with alcohol-related disorders. Alateen is specifically geared toward young people dealing with the effects of a family member with an alcohol related disorder. Information on group meetings can be obtained by calling 1-888-4-alanon or going to http://www.al-anon.alateen.org on the web.
    • Co-Dependents Anonymous is a fellowship of men and women whose common purpose is to develop healthy relationships. The only requirement for membership is a desire for healthy and fulfilling relationships. The web site is http://www.codependents.org and meetings occur throughout the Washington, D.C. area.

Much of the information on this page, as well as additional information on alcoholism and related problems, can be found on the National Institute on Alcohol Abuse and Alcoholism (NIAAA) web site at http://www.niaaa.nih.gov.



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