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FAQ's on Alcohol Abuse and Alcoholism (For the General Public)
1. What is alcoholism?
Alcoholism, also known as alcohol dependence, is a disease that includes the
following four symptoms:
- Craving
--A strong need, or urge, to drink.
- Loss of control
--Not being able to stop drinking once drinking has
begun.
- Physical dependence
--Withdrawal symptoms, such as nausea, sweating,
shakiness, and anxiety after stopping drinking.
- Tolerance
--The need to drink greater amounts of alcohol to get
"high."
For clinical and research purposes, formal diagnostic criteria
for alcoholism also have been developed. Such criteria are included in the
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, published
by the American Psychiatric Association, as well as in the International
Classification Diseases, published by the World Health Organization. (See also
"Publications," Alcohol Alert No. 30: Diagnostic Criteria for Alcohol Abuse and
Dependence.)
2. Is alcoholism a disease?
Yes, alcoholism is a disease. The craving that an alcoholic feels for
alcohol can be as strong as the need for food or water. An alcoholic will
continue to drink despite serious family, health, or legal problems.
Like many other diseases, alcoholism is chronic, meaning that it
lasts a person's lifetime; it usually follows a predictable course; and it has
symptoms. The risk for developing alcoholism is influenced both by a person's
genes and by his or her lifestyle. (See also "Publications," Alcohol Alert No.
30: Diagnostic Criteria for Alcohol Abuse and Dependence.)
3. Is alcoholism inherited?
Research shows that the risk for developing alcoholism does indeed run in
families. The genes a person inherits partially explain this pattern, but
lifestyle is also a factor. Currently, researchers are working to discover the
actual genes that put people at risk for alcoholism. Your friends, the amount of
stress in your life, and how readily available alcohol is also are factors that
may increase your risk for alcoholism.
But remember: Risk is not destiny. Just because alcoholism tends
to run in families doesn't mean that a child of an alcoholic parent will
automatically become an alcoholic too. Some people develop alcoholism even
though no one in their family has a drinking problem. By the same token, not all
children of alcoholic families get into trouble with alcohol. Knowing you are at
risk is important, though, because then you can take steps to protect yourself
from developing problems with alcohol. (See also "Publications," A Family
History of Alcoholism - Are You at Risk?; Alcohol Alert No. 18: The Genetics of
Alcoholism.)
4. Can alcoholism be cured?
No, alcoholism cannot be cured at this time. Even if an alcoholic hasn't
been drinking for a long time, he or she can still suffer a relapse. Not
drinking is the safest course for most people with alcoholism.
5. Can alcoholism be treated?
Yes, alcoholism can be treated. Alcoholism treatment programs use both
counseling and medications to help a person stop drinking. Treatment has helped
many people stop drinking and rebuild their lives. (See also "Publication,"
Alcohol Alert No. 49: New Advances in Alcoholism Treatment.)
6. Which medications treat alcoholism?
Three oral medications--disulfiram (Antabuse®), naltrexone (Depade®, ReVia®),
and acamprosate (Campral®)--are currently approved to treat alcohol dependence.
In addition, an injectable, long-acting form of naltrexone (Vivitrol®) is
available. These medications have been shown to help people with dependence
reduce their drinking, avoid relapse to heavy drinking, and achieve and maintain
abstinence. Naltrexone acts in the brain to reduce craving for alcohol after
someone has stopped drinking. Acamprosate is thought to work by reducing
symptoms that follow lengthy abstinence, such as anxiety and insomnia.
Disulfiram discourages drinking by making the person taking it feel sick after
drinking alcohol.
Other types of drugs are available to help manage symptoms of
withdrawal (such as shakiness, nausea, and sweating) if they occur after someone
with alcohol dependence stops drinking.
Although medications are available to help treat alcoholism,
there is no "magic bullet." In other words, no single medication is available
that works in every case and/or in every person. Developing new and more
effective medications to treat alcoholism remains a high priority for
researchers. (See also "News Releases," Jan. 17, 1995: Naltrexone Approved for
Alcoholism Treatment and "Publication," Alcohol Alert No. 61: Neuroscience
Research and Therapeutic Targets.)
7. Does alcoholism treatment work?
Alcoholism treatment works for many people. But like other chronic
illnesses, such as diabetes, high blood pressure, and asthma, there are varying
levels of success when it comes to treatment. Some people stop drinking and
remain sober. Others have long periods of sobriety with bouts of relapse. And
still others cannot stop drinking for any length of time. With treatment, one
thing is clear, however: the longer a person abstains from alcohol, the more
likely he or she will be able to stay sober.
8. Do you have to be an alcoholic to experience problems?
No. Alcoholism is only one type of an alcohol problem. Alcohol abuse can be
just as harmful. A person can abuse alcohol without actually being an
alcoholic--that is, he or she may drink too much and too often but still not be
dependent on alcohol. Some of the problems linked to alcohol abuse include not
being able to meet work, school, or family responsibilities; drunk-driving
arrests and car crashes; and drinking-related medical conditions. Under some
circumstances, even social or moderate drinking is dangerous--for example, when
driving, during pregnancy, or when taking certain medications.
9. Are specific groups of people more likely to have problems?
Alcohol abuse and alcoholism cut across gender, race, and nationality. In
the United States, 17.6 million people--about l in every 12 adults--abuse
alcohol or are alcohol dependent. In general, more men than women are alcohol
dependent or have alcohol problems. And alcohol problems are highest among young
adults ages 18-29 and lowest among adults ages 65 and older. We also know that
people who start drinking at an early age--for example, at age 14 or
younger--are at much higher risk of developing alcohol problems at some point in
their lives compared to someone who starts drinking at age 21 or after. (See
also "News Releases," June 10, 2004 "Alcohol Abuse Increases, Dependence
Declines Across Decade: Young Adult Minorities Emerge As High-Risk Subgroups"
and July 3, 2006 "Early Drinking Linked to Higher Lifetime Alcoholism Risk. See
also Alcohol Alert No. 55: Alcohol and Minorities: An Update.)
10. How can you tell if someone has a problem?
Answering the following four questions can help you find out if you or a
loved one has a drinking problem:
- Have you ever felt you should cut down on your drinking?
- Have people annoyed you by criticizing your drinking?
- Have you ever felt bad or guilty about your drinking?
- Have you ever had a drink first thing in the morning to steady your
nerves or to get rid of a hangover?
One "yes" answer suggests a possible alcohol problem. More than
one "yes" answer means it is highly likely that a problem exists. If you think
that you or someone you know might have an alcohol problem, it is important to
see a doctor or other health care provider right away. They can help you
determine if a drinking problem exists and plan the best course of action.
11. Can a problem drinker simply cut down?
It depends. If that person has been diagnosed as an alcoholic, the answer is
"no." Alcoholics who try to cut down on drinking rarely succeed. Cutting out
alcohol--that is, abstaining--is usually the best course for recovery. People
who are not alcohol dependent but who have experienced alcohol-related problems
may be able to limit the amount they drink. If they can't stay within those
limits, they need to stop drinking altogether. (See the question 13, "What is a
safe level of drinking?") (See also "Publications/Pamphlets and Brochures," How
to Cut Down on Your Drinking.)
12. If an alcoholic is unwilling to get help, what can you do
about it?
This can be a challenge. An alcoholic can't be forced to get help except
under certain circumstances, such as a traffic violation or arrest that results
in court-ordered treatment. But you don't have to wait for someone to "hit rock
bottom" to act. Many alcoholism treatment specialists suggest the following
steps to help an alcoholic get treatment:
Stop all "cover ups." Family members often make excuses to
others or try to protect the alcoholic from the results of his or her drinking.
It is important to stop covering for the alcoholic so that he or she experiences
the full consequences of drinking.
Time your intervention. The best time to talk to the drinker
is shortly after an alcohol-related problem has occurred--like a serious family
argument or an accident. Choose a time when he or she is sober, both of you are
fairly calm, and you have a chance to talk in private.
Be specific. Tell the family member that you are worried
about his or her drinking. Use examples of the ways in which the drinking has
caused problems, including the most recent incident.
State the results. Explain to the drinker what you will do
if he or she doesn't go for help--not to punish the drinker, but to protect
yourself from his or her problems. What you say may range from refusing to go
with the person to any social activity where alcohol will be served, to moving
out of the house. Do not make any threats you are not prepared to carry out.
Get help. Gather information in advance about treatment
options in your community. If the person is willing to get help, call
immediately for an appointment with a treatment counselor. Offer to go with the
family member on the first visit to a treatment program and/or an Alcoholics
Anonymous meeting.
Call on a friend. If the family member still refuses to get
help, ask a friend to talk with him or her using the steps just described. A
friend who is a recovering alcoholic may be particularly persuasive, but any
person who is caring and nonjudgmental may help. The intervention of more than
one person, more than one time, is often necessary to coax an alcoholic to seek
help.
Find strength in numbers. With the help of a health care
professional, some families join with other relatives and friends to confront an
alcoholic as a group. This approach should only be tried under the guidance of a
health care professional who is experienced in this kind of group intervention.
Get support. It is important to remember that you are not
alone. Support groups offered in most communities include Al-Anon, which holds
regular meetings for spouses and other significant adults in an alcoholic's
life, and Alateen, which is geared to children of alcoholics. These groups help
family members understand that they are not responsible for an alcoholic's
drinking and that they need to take steps to take care of themselves, regardless
of whether the alcoholic family member chooses to get help.
You can call the National Drug and Alcohol Treatment Referral
Routing Service (Center for Substance Abuse Treatment) at 1-800-662-HELP (4357)
for information about treatment programs in your local community and to speak to
someone about an alcohol problem.
13. What is a safe level of drinking?
For most adults, moderate alcohol use--up to two drinks per day for men and
one drink per day for women and older people--causes few if any problems. (One
drink equals one 12-ounce bottle of beer or wine cooler, one 5-ounce glass of
wine, or 1.5 ounces of 80-proof distilled spirits.)
Certain people should not drink at all, however:
- Women who are pregnant or trying to become pregnant
- People who plan to drive or engage in other activities that require
alertness and skill (such as driving a car)
- People taking certain over-the-counter or prescription medications
- People with medical conditions that can be made worse by drinking
- Recovering alcoholics
- People younger than age 21
(See also "Publications" Harmful Interactions: Mixing Alcohol
With Medicines and Drinking and Your Pregnancy; Alcohol Alert No. 27:
Alcohol-Medication Interactions; Alcohol Alert No 50: Fetal Alcohol Exposure and
the Brain; and Alcohol Alert No. 52: Alcohol and Transportation Safety)
14. Is it safe to drink during pregnancy?
No, alcohol can harm the baby of a mother who drinks during pregnancy.
Although the highest risk is to babies whose mothers drink heavily, it is not
clear yet whether there is any completely safe level of alcohol during
pregnancy. For this reason, the U.S. Surgeon General released advisories in 1981
and again in 2005 urging women who are pregnant or may become pregnant to
abstain from alcohol (http://www.lhvpn.net/hhspress.html). The damage caused by
prenatal alcohol includes a range of physical, behavioral, and learning problems
in babies Babies most severely affected have what is called Fetal Alcohol
Syndrome (FAS). These babies may have abnormal facial features and severe
learning disabilities. Babies can also be born with mild disabilities without
the facial changes typical of FAS.
(See also "Publications" Alcohol Alert No.50: Fetal Alcohol
Syndrome and the Brain; "Pamphlets and Brochures," Drinking and Your Pregnancy.)
15. Does alcohol affect older people differently?
Alcohol's effects do vary with age. Slower reaction times, problems with
hearing and seeing, and a lower tolerance to alcohol's effects put older people
at higher risk for falls, car crashes, and other types of injuries that may
result from drinking.
Older people also tend to take more medicines than younger
people. Mixing alcohol with over-the-counter or prescription medications can be
very dangerous, even fatal. (See the question 18, "When taking medications, must
you stop drinking?" for more information.) In addition, alcohol can make many of
the medical conditions common in older people, including high blood pressure and
ulcers, more serious. Physical changes associated with aging can make older
people feel "high" even after drinking only small amounts of alcohol. So even if
there is no medical reason to avoid alcohol, older men and women should limit
themselves to one drink per day. (See also "Publications/Pamphlets and
Brochures" Age Page: Alcohol Use and Abuse.)
16. Does alcohol affect women differently?
Yes, alcohol affects women differently than men. Women become more impaired
than men do after drinking the same amount of alcohol, even when differences in
body weight are taken into account. This is because women's bodies have less
water than men's bodies. Because alcohol mixes with body water, a given amount
of alcohol becomes more highly concentrated in a woman's body than in a man's.
In other words, it would be like dropping the same amount of alcohol into a much
smaller pail of water. That is why the recommended drinking limit for women is
lower than for men.
In addition, chronic alcohol abuse takes a heavier physical toll
on women than on men. Alcohol dependence and related medical problems, such as
brain, heart, and liver damage, progress more rapidly in women than in men. (See
also "Publications," Alcohol Alert No. 62: Alcohol-An Important Women's Health
Issue.)
17. Is alcohol good for your heart?
Studies have shown that moderate drinkers are less likely to die from one
form of heart disease than are people who do not drink any alcohol or who drink
more.
If you are a nondrinker, however, you should not start drinking
solely to benefit your heart. You can guard against heart disease by exercising
and eating foods that are low in fat. And if you are pregnant, planning to
become pregnant, have been diagnosed as alcoholic, or have another medical
condition that could make alcohol use harmful, you should not drink.
If you can safely drink alcohol and you choose to drink, do so
in moderation. Heavy drinking can actually increase the risk of heart failure,
stroke, and high blood pressure, as well as cause many other medical problems,
such as liver cirrhosis. (See also "Publications," Alcohol Alert No. 16:
Moderate Drinking and Alcohol Alert No. 45: Alcohol Coronary Heart Disease.)
18. When taking medications, must you stop drinking?
Possibly. More than 150 medications interact harmfully with alcohol. These
interactions may result in increased risk of illness, injury, and even death.
Alcohol's effects are heightened by medicines that depress the central nervous
system, such as sleeping pills, antihistamines, antidepressants, anti-anxiety
drugs, and some painkillers. In addition, medicines for certain disorders,
including diabetes, high blood pressure, and heart disease, can have harmful
interactions with alcohol. If you are taking any over-the-counter or
prescription medications, ask your doctor or pharmacist if you can safely drink
alcohol. (See also "Publications," Harmful Interactions; Mixing Alcohol with
Medicines; Alcohol Alert No. 27: Alcohol-Medication Interactions.)
19. How can a person get help for an alcohol problem?
There are many national and local resources that can help. The National Drug
and Alcohol Treatment Referral Routing Service provides a toll-free telephone
number, 1-800-662-HELP (4357), offering various resource information. Through
this service you can speak directly to a representative concerning substance
abuse treatment, request printed material on alcohol or other drugs, or obtain
local substance abuse treatment referral information in your State (see
Treatment Referral Information).
Many people also find support groups a helpful aid to recovery.
The following list includes a variety of resources:
- Al-Anon/Alateen
- Alcoholics Anonymous (AA)
- National Association for Children of Alcoholics (NACOA)
- National Clearinghouse for Alcohol and Drug Information (NCADI)
Source: National Institutes of Health; National
Institute on Alcohol Abuse and Alcoholism (NIAAA)
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