Alcoholism, also known as "alcohol dependence," is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law. It includes four symptoms:
Craving -- A strong need, or compulsion, to drink.
Impaired control -- The inability to limit one's drinking on any given occasion.
Physical dependence -- Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, when alcohol use is stopped after a period of heavy drinking.
Tolerance -- The need for increasing amounts of alcohol in order to feel its effects.
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.
Alcohol Abuse vs. Alcohol Dependence
Q: What
is the difference between alcohol abuse and alcohol dependence?
A:
Alcohol abuse is described as any "harmful use" of alcohol.
The Diagnostic and Statistical Manual of Mental Disorders IV describes alcohol abusers as those who drink despite recurrent social, interpersonal, and legal problems as a result of alcohol use. Harmful use implies alcohol use that causes either physical or mental damage.
Those who are alcohol dependent meet all of the criteria of alcohol abuse, but the will also exhibit some or all of the following:
| Narrowing of the drinking repertoire (drinking only one brand or type of
alcoholic beverage).| Drink-seeking behavior (only going to social events that will include
drinking, or only hanging out with others who drink). | Alcohol tolerance (having to drink increasing amounts to achieve previous
effects). | Withdrawal symptoms (getting physical symptoms after going a short period
without drinking). | Drinking to relieve or avoid withdrawal symptoms (such as drinking to stop
the shakes or to "cure" a hangover). | Subjective awareness of the compulsion to drink or craving for alcohol
(whether they admit it to others or not). | A return to drinking after a period of abstinence (deciding to quit
drinking and not being able to follow through). | |
Those who have become alcohol dependent generally require outside help to stop drinking, which could include detoxification, medical treatment, counseling and/or self-help group support.
* Taking the drug more often or in larger amounts than intended.
* Unsuccessful attempts to quit; persistent desire, craving.
* Excessive time spent in drug seeking.
* Feeling intoxicated at inappropriate times, or feeling withdrawal symptoms from a drug at such times.
* Giving up other things for it.
* Continued use, despite knowledge of harm to oneself and others.
* Marked tolerance in which the amount needed to satisfy increases at first before leveling off.
* Characteristic withdrawal symptoms for particular drugs.
* Taking the drug to relieve or avoid withdrawal.
Before applying a test of the nine criteria, the expert first determines if the symptoms have persisted for at least a month or have occurred repeatedly over a longer period of time.
Asked about the tobacco executives' testimony on addiction, Dr. Kozlowski said, "In a way, I can see how they could say that. It has to do with a mistaken image of what addiction is, and I have many well-educated, intelligent people say something like that to me. People often think of a person taking one injection of heroin and becoming hopelessly addicted for the rest of their lives. That is wrong."
In addition, he said, when people tend to think of the high that heroin produces, one that is about as intense as cocaine and alcohol, they cannot believe cigarettes are in the same category. And they are not. Even though in large doses nicotine can cause a strong high and hallucinations, the doses used in cigarettes produce only a very mild high.
But researchers now know, says Dr. Jack Henningfield, chief of clinical pharmacology at the Addiction Research Center of the Government's National Institute on Drug Abuse, that many qualities are related to a drug's addictiveness, and the level of intoxication it produces may be one of the least important.
If one merely asks how much pleasure the drugs produce, as researchers used to do and tobacco companies still do, then heroin or cocaine and nicotine do not seem to be in the same category. Dr. Kozlowki said, "It's not that cigarettes are without pleasure, but the pleasure is not in the same ball park with heroin."
But now, he said, there are more questions to ask. "If the question is How hard is it to stop? then nicotine a very impressive drug," he said. "Its urges are very similar to heroin."
Among the properties of a psychoactive drug - how much craving it can cause, how severe is the withdrawal, how intense a high it brings - each addicting drug has its own profile.
Heroin has a painful, powerful withdrawal, as does alcohol. But cocaine has little or no withdrawal. On the other hand, cocaine is more habit-forming in some respects, it is more reinforcing in the scientific terminology, meaning that animals and humans will seek to use it frequently in short periods of time, even over food and water.
Drugs rank differently on the scale of how difficult they are to quit as well, with nicotine rated by most experts as the most difficult to quit.
Moreover, it is not merely the drug that determines addiction, says Dr. john R. Hughes, an addiction expert at the University of Vermont. It is also the person, and the circumstances in the person's life. A user may be able to resist dependence at one time and not at another.
A central property of addiction is the user's control over the substance. With all drugs. including heroin, many are occasional users. The addictive property of the substance can be measured by how many users maintain a casual habit and how many are persistent, regular users.
According to large Government surveys of alcohol users, only about 15 percent are regular. dependent drinkers. Among cocaine users, about 8 percent become dependent. For cigarettes, the percentage is reversed. About 90 percent of smokers are persistent daily users, and 55 percent become dependent by official American Psychiatric Association criteria, according to a study by Dr. Naomi Breslau of the Henry Ford Health Sciences Center in Detroit. Only 10 percent are occasional users.
Surveys also indicate that two-thirds to four-fifths of smokers want to quit but cannot, even after a number of attempts. Dr. John Robinson, a psychologist who works for the R. J. Reynolds Tobacco Company, contests the consensus view of nicotine as addictive. Using the current standard definition of addiction, he said at a recent meeting on nicotine addiction, he could not distinguish "crack smoking from coffee drinking, glue sniffing from jogging. heroin from carrots and cocaine from colas."
It is not that Dr. Robinson and other scientists supported by tobacco
companies disagree with the main points made by mainstream scientists. but that
they define addiction differently. Dr. Robinson says intoxication that is
psychologically debilitating is the major defining trait of an addicting
substance. It is a feature that was part of standard definitions of the 1950's,
and is still linked to popular ideas about addiction, but which experts now say
is too simplistic and has been left behind as scientific evidence accumulates.
Yes. Alcoholism is a chronic, often progressive disease with symptoms that include a strong need to drink despite negative consequences, such as serious job or health problems. Like many other diseases, it has a generally predictable course, has recognized symptoms, and is influenced by both genetic and environmental factors that are being increasingly well defined.
One of the difficulties in recognizing alcoholism as a
disease is it just plain doesn't seem like one. It doesn't look, sound, smell
and it certainly doesn't act like a disease. To make matters worse, generally it
denies it exists and resists treatment.
Alcoholism has been recognized for many years by professional medical
organizations as a primary, chronic, progressive and sometimes fatal disease.
The National Council on Alcoholism and Drug Dependence offers a detailed and
complete definition of alcoholism but probably the most simple way to describe it is "a
mental obsession that causes a physical compulsion to drink."
Mental obsession? Did you ever wake up in the morning with a song playing over
and over in your head? It might have been a commercial jingle you heard on
television, or a song from the radio, but it kept playing ... and playing and
playing.
Remember what that was like? No matter what you did, that silly tune kept on
playing. You could try to whistle or sing another song or turn on the radio and
listen to another tune, but the one in your head just kept on playing. Think
about it. There was something going on in your mind that
you didn't put there and, no matter how hard you tried, couldn't get out!
That is an example of a simple mental obsession -- a thought process over which
you have no control. Such is the nature of the disease of
alcoholism.
When the drinking "song" starts playing in the mind of an alcoholic,
he is powerless. He didn't put the song there and the only way to get it to stop is to take
another drink.
The problem is the alcoholic's mental obsession with alcohol is much more subtle
than a song playing in his mind. In fact, he may not even know it's there. All
he knows is he suddenly has an urge to take a drink -- a physical compulsion to
drink.
Compounding the problem is the progressive nature of the disease. In its early
stages, taking one or two drinks may be all it takes to get the "song"
to stop. But soon it takes six or seven and later maybe ten or twelve. Somewhere
down the road the only time the song stops is when he passes out.
The progression of the disease is so subtle and usually takes place over such an
extended period of time, that even the alcoholic himself failed to notice the
point at which he lost control -- and alcohol took over -- his life.
No wonder denial is an almost universal symptom of the disease. For those who
have come to the realization that they do have a problem, help
may be as close as the white pages of the telephone directory. But for those who
need help and do not want it, intervention
may be the only alternative.
Research shows that alcohol adversely affects the brain. When health professionals encounter patients who are having cognitive difficulties, such as impaired memory or reasoning ability, alcohol use may be the cause of the problem. When treating patients who have abused alcohol, it may be of value to attempt to identify the level of any impairment and to modify the treatment accordingly.
Some researchers have investigated whether or not there is measurable alcohol-related cognitive impairment among nonalcoholic social drinkers. Their findings suggest a dose-response relationship between alcohol consumption and diminished scores on certain neuropsychological tests (e.g., Parker & Noble 1977; Parker et al. 1983). Statistically significant decreases in test performance have been found for people whose self-reported alcohol consumption was in the range of what was considered social drinking. This is not to say these people were clinically impaired, only that they exhibited certain performance deficits that correlated with alcohol consumption. It is important to note that similar correlations from other studies have not been found to be consistently significant. For example, the results of one general population study (Bergman et al. 1983) showed no correlation between self-reported alcohol consumption and neuropsychological test scores; other findings (Emmerson et al. 1988) failed to show a simple dose-response relationship. In a recent review of such studies, Parsons (1986) concluded that data on the relationship of cognitive impairment to amount of alcohol consumed by social drinkers are inconclusive.
Alcoholics in treatment present a different picture. Although most alcoholics entering treatment do not have decreased overall intelligence scores, approximately 45 to 70 percent of these patients have specific deficits in problem solving, abstract thinking, concept shifting, psychomotor performance, and difficult memory tasks (Parsons & Leber 1981; Eckardt & Martin 1986; Tabakoff & Petersen 1988). Such deficits usually are not apparent without neuropsychological testing. In addition, structural changes in the brains of alcoholics have been reported (Ron 1979; Wilkinson 1987), as well as reduced cerebral blood flow (Ishikawa et al. 1986) and altered electrical activity (Porjesz & Begleiter 1981), but there is not yet any clear evidence implicating these changes as the cause of observed cognitive deficits.
For the most severe alcoholics, serious organic cerebral impairment is a common complication, occurring in about 10 percent of patients (Horvath 1975). The diverse signs of severe brain dysfunction that persist after cessation of alcohol consumption have been conceptualized in terms of two organic mental disorders: alcohol amnestic disorder (memory disorder) and dementia associated with alcoholism (Lishman 1981; American Psychiatric Association 1987). Recently however, it has been recognized that these two disorders are not mutually exclusive and that some features of each often coexist in the same patient (Martin & Eckardt 1985). Alcohol amnestic disorder, commonly called Korsakoff's psychosis or Wernicke-Korsakoff syndrome, is characterized by short-term memory, impairments and behavioral changes that occur without clouding of consciousness or general loss of intellectual abilities. Dementia associated with alcoholism consists of global loss of intellectual abilities with an impairment in memory function, together with disturbance(s) of abstract thinking, judgment, other higher cortical functions, or personality change without a clouding of consciousness. It has been suggested that subcortical lesions due to nutritional (thiamine) deficiency are characteristic of Korsakoff's, whereas alcoholic dementia is associated more with cortical changes (Victor & Laureno 1978). There is some evidence that a genetic abnormality may predispose some people to Korsakoff's in the presence of excessive alcohol use and malnutrition (Blass & Gibson 1977; Mukherjee et aI. 1987).
Tarter and Edwards (1986) summarize evidence suggesting that neuropsychological impairment in alcoholics may occur for a number of reasons. The toxic effects of alcohol on the brain may cause impairment directly. In addition, some alcoholics may exhibit impairment as an indirect result of alcohol abuse, e.g., they may have experienced a craniocerebral trauma, they may be eating poorly and suffering nutritional deficits (such as thiamine or niacin deficiencies), or they may have cognitive impairments associated with liver disease.
Some alcoholics may have been cognitively impaired before they began drinking. There is some evidence that persons in groups considered to be at risk for alcoholism (e.g., children of alcoholics) are less adept at certain learning tests and visual-spatial integration than are persons in groups not deemed at risk for alcoholism; this area of research is still under active investigation.
Some researchers have observed that cognitive deficits in some alcoholics resemble those seen in normal elderly persons, leading to speculation that alcohol's effect on cognition may be explained as premature aging (Tarter 8 Edwards 1986). However, it is more likely that such deficits are independent of any deficits associated with normal aging (Grant et al. 1984; Cutting 1988).
Laying aside issues of etiology, evidence indicates that some cognitive impairment in alcoholics is reversible. Researchers (Albert et al. 1982; Grant et al. 1984; Goldman 1986, 1987) report apparent "spontaneous" recovery of cognitive function (recovery seen after the passage of time with no active intervention) among abstinent alcoholics, a result that may be due solely to the absence of alcohol but that also may be due in part to other changes, such as better nutrition and opportunities for social interaction provided in an alcohol treatment setting. There is some evidence that cognitive training and practice experience (remedial mental exercises) can facilitate recovery from impairment (Godfrey et al. 1985; Goldman 1986,1987).
Because even with prolonged abstinence many alcoholic patients with chronic organic mental disorders may exhibit only modest clinical improvement in brain functioning, there is a need for pharmacological interventions to complement behavioral methods. Recent findings that pharmacological intervention may be useful in restoring some cognitive ability (McEntee & Mair 1980) are encouraging.
Although degree of cognitive impairment may not be a clinically significant predictor of post-treatment alcohol consumption (Donovan et al. 1987; Eckardt et al. 1988), identifying cognitive impairment may have implications for successfully treating some patients. Particularly in the first weeks of abstinence during treatment, cognitive impairments may make it difficult for some alcoholics to benefit from the educational and skill development sessions that are important components of many treatment programs (McCrady & Smith 1986; McCrady 1987). For example, Becker and Jaffe (1984) reported that alcoholics who were tested soon after beginning abstinence were unable to recall treatment-related information presented in a film that was part of the regular treatment program. An implication of such findings is that information presented to alcoholics during the period of impairment in the early weeks of abstinence should be repeated at later stages in the treatment program. Alternatively, presentation of treatment-related information should be delayed until tests indicate some improvement in cognitive function.
Alcohol and Cognition - A Commentary by
NIAAA Director Enoch Gordis, M.D.
Awareness of alcohol's effects on cognition can help general health care providers identify alcoholics and refer them to appropriate treatment. Awareness also can assist the efforts of alcoholism treatment personnel to maximize the potential benefit of treatment for their patients.
In general health care situations, practitioners should use standard alcoholism assessment instruments to determine the extent of alcohol use by patients who show signs of cognitive dysfunction. Patients in whom alcohol use is identified as either a primary or a contributing cause of cognitive dysfunction must be referred to alcoholism treatment. Evidence suggests that some cognitive impairment in alcoholics is reversible. Moreover, cognitive deterioration will worsen with continued drinking.
In addition, alcoholism treatment personnel should know that alcohol-induced cognitive impairment may make it difficult during the first weeks of absence for some of their patients to benefit from exposure to the full range of treatment services. Although it may not be possible or necessary for treatment programs to administer extensive neuropsychiatric tests to all patients, a simple test of the patient's ability to benefit from the didactic elements of alcoholism treatment can be made. One test might be to determine what a patient remembers from an initial counseling session.
If there is evidence of cognitive deficiency, patients must be allowed time to recover adequate cognitive function so that, at a minimum, information provided during treatment can be retained. However, other important elements of rehabilitation, such as improving patient nutritional status and exposure to physical exercise and resocialization activities, can be undertaken immediately. As cognitive function improves, patients can begin to participate in such treatment components as individual and group therapy, educational programs, and introduction to Alcoholics Anonymous, with a better chance for understanding--and perhaps for acting on--the information provided.
Alcohol and Tolerance
Alcohol consumption interferes with many bodily functions and affects behavior. However, after chronic alcohol consumption, the drinker often develops tolerance to at least some of alcohol's effects. Tolerance means that after continued drinking, consumption of a constant amount of alcohol produces a lesser effect or increasing amounts of alcohol are necessary to produce the same effect (1). Despite this uncomplicated definition, scientists distinguish between several types of tolerance that are produced by different mechanisms.
Tolerance to alcohol's effects influences drinking behavior and drinking consequences in several ways. This Alcohol Alert describes how tolerance may encourage alcohol consumption, contributing to alcohol dependence and organ damage; affect the performance of tasks, such as driving, while under the influence of alcohol; contribute to the ineffectiveness or toxicity of other drugs and medications; and may contribute to the risk for alcoholism.
Functional Tolerance
Humans and animals develop tolerance when their brain functions adapt to compensate for the disruption caused by alcohol in both their behavior and their bodily functions. This adaptation is called functional tolerance (2). Chronic heavy drinkers display functional tolerance when they show few obvious signs of intoxication even at high blood alcohol concentrations (BAC's), which in others would be incapacitating or even fatal (3). Because the drinker does not experience significant behavioral impairment as a result of drinking, tolerance may facilitate the consumption of increasing amounts of alcohol. This can result in physical dependence and alcohol-related organ damage.
However, functional tolerance does not develop at the same rate for all alcohol effects (4-6). Consequently, a person may be able to perform some tasks after consuming alcohol while being impaired in performing others. In one study, young men developed tolerance more quickly when conducting a task requiring mental functions, such as taking a test, than when conducting a task requiring eye-hand coordination (4), such as driving a car. Development of tolerance to different alcohol effects at different rates also can influence how much a person drinks. Rapid development of tolerance to unpleasant, but not to pleasurable, alcohol effects could promote increased alcohol consumption (7).
Different types of functional tolerance and the factors influencing their development are described below. During repeated exposure to low levels of alcohol, environmental cues and processes related to memory and learning can facilitate tolerance development; during exposure to high levels of alcohol, tolerance may develop independently of environmental influences.
Acute tolerance. Although tolerance to most alcohol effects develops over time and over several drinking sessions, it also has been observed within a single drinking session. This phenomenon is called acute tolerance (2). It means that alcohol-induced impairment is greater when measured soon after beginning alcohol consumption than when measured later in the drinking session, even if the BAC is the same at both times (8-10).
Acute tolerance does not develop to all effects of alcohol but does develop to the feeling of intoxication experienced after alcohol consumption (4). This may prompt the drinker to consume more alcohol, which in turn can impair performance or bodily functions that do not develop acute tolerance.
Environment-dependent tolerance. The development of tolerance to alcohol's effects over several drinking sessions is accelerated if alcohol is always administered in the same environment or is accompanied by the same cues. This effect has been called environment-dependent tolerance. Rats that regularly received alcohol in one room and a placebo in a different room demonstrated tolerance to the sedative and temperature-lowering effects of alcohol only in the alcohol-specific environment (11). Similar results were found when an alcohol-induced increase in heart rate was studied in humans (12). When the study subjects always received alcohol in the same room, their heart rate increased to a lesser extent after drinking in that room than in a new environment.
Environment-dependent tolerance develops even in "social" drinkers in response to alcohol-associated cues. In a study analyzing alcohol's effects on the performance of an eye-hand coordination task, a group of men classified as social drinkers received alcohol either in an office or in a room resembling a bar. Most subjects performed the task better (i.e., were more tolerant) when drinking in the bar-like environment (13). This suggests that for many people, a bar contains cues that are associated with alcohol consumption and promote environment-dependent tolerance.
Learned tolerance. The development of tolerance also can be accelerated by practicing a task while under the influence of alcohol. This phenomenon is called behaviorally augmented (i.e., learned) tolerance. It first was observed in rats that were trained to navigate a maze while under the influence of alcohol (14). One group of rats received alcohol before their training sessions; the other group received the same amount of alcohol after their training sessions. Rats that practiced the task while under the influence of alcohol developed tolerance more quickly than rats practicing without prior alcohol administration.
Humans also develop tolerance more rapidly and at lower alcohol doses if they practice a task while under the influence of alcohol. When being tested on a task requiring eye-hand coordination while under the influence of alcohol, people who had practiced after ingesting alcohol performed better than people who had practiced before ingesting alcohol (15). Even subjects who only mentally rehearsed the task after drinking alcohol showed the same level of tolerance as those who actually practiced the task while under the influence of alcohol (15).
The expectation of a positive outcome or reward after successful task performance is an important component of the practice effect on tolerance development. When human subjects knew they would receive money or another reward for successful task perfmance while under the influence of alcohol, they developed tolerance more quickly than if they did not expect a reward (16). The motivation to perform better contributes to the development of learned tolerance.
Learned and environment-dependent tolerance have important consequences for situations such as drinking and driving. Repeated practice of a task while under the influence of low levels of alcohol, such as driving a particular route, could lead to the development of tolerance, which in turn could reduce alcohol-induced impairment (16). However, the tolerance acquired for a specific task or in a specific environment is not readily transferable to new conditions (17,18). A driver encountering a new environment or an unexpected situation could instantly lose any previously acquired tolerance to alcohol's impairing effects on driving performance.
Environment-independent tolerance. Exposure to large quantities of alcohol can lead to the development of functional tolerance independent of environmental influences. This was demonstrated in rats that inhaled alcohol vapors (19). In another study, mice demonstrated tolerance in environments different from the one in which the alcohol was administered (20). Significantly larger alcohol doses were necessary to establish this environment-independent tolerance than to establish environment-dependent tolerance (20)
Metabolic Tolerance
Tolerance that results from a more rapid elimination of alcohol from the body is called metabolic tolerance (2). It is associated with a specific group of liver enzymes that metabolize alcohol and that are activated after chronic drinking (21,22). Enzyme activation increases alcohol degradation and reduces the time during which alcohol is active in the body (2), thereby reducing the duration of alcohol's intoxicating effects.
However, certain of these enzymes also increase the metabolism of some other drugs and medications, causing a variety of harmful effects on the drinker. For example, rapid degradation of sedatives (e.g., barbiturates) (23) can cause tolerance to them and increase the risk for their use and abuse. Increased metabolism of some prescription medications, such as those used to prevent blood clotting and to treat diabetes, reduces their effectiveness in chronic drinkers or even in recovering alcoholics (24). Increased degradation of the common painkiller acetaminophen produces substances that are toxic to the liver (25) and that can contribute to liver damage in chronic drinkers.
Tolerance and the Predisposition to Alcoholism
Animal studies indicate that some aspects of tolerance are genetically determined. Tolerance development was analyzed in rats that were bred to prefer or not prefer alcohol over water (26,27). The alcohol-preferring rats developed acute tolerance to some alcohol effects more rapidly and/or to a greater extent than the non-preferring rats (26). In addition, only the alcohol-preferring rats developed tolerance to alcohol's effects when tested over several drinking sessions (27). These differences suggest that the potential to develop tolerance is genetically determined and may contribute to increased alcohol consumption.
In humans, genetically determined differences in tolerance that may affect drinking behavior were investigated by comparing sons of alcoholic fathers (SOA's) with sons of nonalcoholic fathers (SONA's). Several studies found that SOA's were less impaired by alcohol than SONA's (28,29). Other studies found that, compared with SONA's, SOA's were affected more strongly by alcohol early in the drinking session but developed more tolerance later in the drinking session (30). These studies suggest that at the start of drinking, when alcohol's pleasurable effects prevail, SOA's experience these strongly; later in the drinking session, when impairing effects prevail, SOA's do not experience these as strongly because they have developed tolerance (30). This predisposition could contribute to increased drinking and the risk for alcoholism in SOA's.
Alcohol and Tolerance--A Commentary by
NIAAA Director Enoch Gordis, M.D.
Tolerance can be a useful clue for clinicians in identifying patients who may be at risk for developing alcohol-related problems. For example, younger patients who are early in their drinking histories and who report that they can "hold their liquor well" may be drinking at rates that will place them at risk for medical complications from alcohol use, including alcoholism. The fact that tolerance to all of alcohol's effects does not develop simultaneously is also important; people who are mildly tolerant may exhibit more symptoms of impairment when faced with unfamiliar activities, such as driving in an unknown area, than when they are engaged in routine actions, such as driving home from work. Lastly, although we know that initial sensitivity to alcohol may play a role in the development of alcoholism, the role of tolerance in maintaining addiction to alcohol needs further exploration.
Withdrawal Symptoms
Withdrawal from alcohol dependence can bring on a variety of symptoms which can range from mild shakes to life-threatening delirium tremens and seizures.
Alcohol
Withdrawal
When heavy or frequent drinkers suddenly decide to quit "cold turkey"
they will experience some physical withdrawal symptoms.
Alcohol
Withdrawal Syndrome
The alcohol withdrawal syndrome is a cluster of symptoms observed in persons who
stop drinking alcohol following continuous and heavy consumption.
Addiction
Criteria
Nine criteria for determining if behavior has become addictive.
Alcohol
Withdrawal Syndrome
Some people have mild shakiness and sweats. Some people hallucinate--they hear
and see things that don't exist. The worst form of withdrawal is called
"DTs" (delirium tremens).
Alcohol
Withdrawal Seizures
Untreated, one-third of patients will go on to develop full-blown delirium
tremens, and a small number will develop tonic-clonic status epilepticus.
Delirium
Tremens
Delirium tremens (DT's) is an extremely serious problem which can appear in an
alcohol dependent patient during alcohol withdrawal.
For those suffering from the disease of alcoholism it seems to be an almost universal truth that before things can get better, they have to get worse -- sometimes a lot worse.
They call it "hitting bottom" -- the place an alcoholic must reach before he finally is ready to admit that he has a problem and reaches out for help.
After all, for the true alcoholic, it doesn't seem to him (or her) that he has a problem. He's just having a good time. If everybody would just get off his back, everything would be okay. He's got a disease, but it sure doesn't seem like one and the last thing that would ever occur to him is that he needs help.
Because alcoholism is a progressive disease, there comes a point at which even the most dedicated drunk decides that there just might be a problem.
Alcoholism does not stay in one place. It doesn't hit a certain stage and then level off. It keeps deepening, affecting him physically, mentally, morally and spiritually. On all of those levels he keeps getting worse until finally he hits bottom.
So where is bottom? Nobody really knows.
For some, getting that first DUI might be where the turning point comes. Getting locked up, even for a few hours, and facing the public humiliation of a court date is for some the only signal they need they have a problem.
For others, however, 10 drunk driving arrests have no affect whatsoever. Driving without a license and frequent visits to the local jail don't phase them at all.
Alcoholics have lost driver's licenses, jobs, careers, girlfriends, wives, family and children and have continued to deny they have a drinking problem.
It was always somebody else's fault. His wife just didn't understand him. The only reason he got that DUI was because he was driving a red vehicle and cops watch for red vehicles. He wouldn't have all the problems he's got if it weren't for those MADD mothers!
His boss was a real pain to put up with anyway. His career as a professional was going nowhere fast and besides he enjoys selling used cars -- gets to meet more people.
Some alcoholics go on for many years denying their downward spiral into social, economic and moral decline. But every alcoholic has a "bottom" out there to hit. A place where even the hardest of the hardcore drinkers finally admit that their lives have become unmanageable. If this sounds familiar, there are a few questions that you might want to ask yourself about your own use of alcohol. It doesn't have to get any worse before you can find help putting your life back on track.
The partners of alcoholics often have serious social and psychological problems. However, some of their behavior may result in persistent alcohol related problems in their spouse or husband, or lead to the failure of treatment programs. Many physicians emphasize the importance of this by including the partner in family therapy, or by seeing the partner with or without the patient, for counseling to promote changes in the behavior which encourages their partner's alcoholism.
Many partners of alcoholics suffer anxiety, insomnia, tension and depression. They often feel a strong sense of guilt or anger and have a desire for vengeance, which they may take out on their children or colleagues at work.
In the therapeutic protocol, the partner may be as much a help as an obstacle. There is the supporting partner, on whom the alcoholic and the alcohol abuse specialist can count to help free the alcoholic from dependence, and the inducer partner, who in various ways and for various reasons, encourages the alcoholism of the other.
Often, the partner acts in such a way that the drinker is practically prevented from seeing the problems resulting from their alcohol consumption. For example, when the partner screens the alcoholic by making false excuses to employers for absenteeism, by paying off debts, or by being more attentive when the spouse is drunk than when they are sober. Only when the partner ceases to act as a protector can the drinker confront the real situation.
Another common situation is where the partner does not understand the drinker, gives constant reproaches, excessive surveillance, restrictions, threats, which in the majority of cases lead the alcoholic to drink more.
For reasons which are not clearly established, it seems that many alcoholic girls marry an alcoholic. These women often behave in such a way as to encourage continuation of their partner's alcohol abuse by making excuses and tolerating the situation.
With the help of alcohol abuse specialists, partners of alcoholics can overcome their anxieties and stop acting in a way which encourages their partner to drink.
Many studies have emphasized the importance of the support of the partner and family. Encouragement given by the partner plays a key role in the withdrawal process, during which progress is too often accepted without comment, whilst failure is severely condemned. It is common for an alcoholic to stop drinking or reduce consumption because of changes occurring in the family - behavior is modified. Treatment has a greater chance of success in women if there is support from their spouse. However in almost half of cases, alcoholic women have a partner who also has an alcohol related problem, ensuring a close correlation between the behavior of them both.
CODEPENDENCY
Alcoholism is a disease that affects every member of
the family, to the extent that the kids who make it into the Alateen rooms
report they generally have more problems dealing with the non-drinking parent
than they do the alcoholic.
What? But I don't have a problem! He... him... he's the alcoholic! He's the
one who causes all the problems! He's the one in trouble all the time ...
True, but he's also predictable. Kids can read the alcoholic like a book. They
know exactly when it's the right time to ask for extra money, or to go somewhere
with their friends, and also know when it's time to make themselves scarce and
get out of the way. They know the routine as far as the alcoholic is concerned.
But they never know where the bedraggled non-drinking parent is coming from
next.
One minute she (or he as the case may be) is screaming at the
alcoholic -- threatening him with everything from from divorce to death -- and
the next minute she may be compassionately rescuing him from the consequences of
his latest episode -- dutifully cleaning up his messes, making excuses for him
and accepting an increasing degree of unacceptable behavior.
The truth is the disease of alcoholism has affected her life, her attitude and her thinking perhaps more
dramatically than it has the drinking spouse and she may not even realize it.
Why? Because it crept up on her slowly.
A few years back, there was a story going around the 12-step rooms about a frog in the water. It goes like this:
If you put a frog into a pan of boiling water, it will jump out faster than the
eye can see. But if you put the frog into a pan of water that is the frog's body
temperature and then slowly turn up the heat the frog will stay in
the water -- even to the point of boiling alive. Why? Because the frog does not
notice the gradual change in temperature.
Alcoholism works the same way... the heat is constantly turned up but nobody
notices. Cunning and baffling! A progressive disease. It may start out with casually accepting unacceptable behavior -- Oh,
he didn't mean that, he just had too much to drink last night. A few years
down the road the behavior has slowly grown more and more intolerable, but it is
still being accepted and becomes the "norm."
She ends up with chaos in her own home that a few short years ago would have
been unthinkable. If she looked out the window and saw the same kind of things
taking place across the street at the neighbor's house, she would probably pick
up the phone and call 9-1-1 to get those people some help!
As that same type of behavior becomes routine in her own home, the last thing
that would occur to her is to pick up the telephone and get help. She has slowly
been drawn into the thinking that the alcoholic should be protected. She has
learned to cover for him, lie for him and hide the truth. She has learned to
keep secrets, no matter how bad the chaos and insanity all around her has
become.
Few who have been affected by the disease of alcoholism realize that by
"protecting" the alcoholic with little lies and deceptions to the
outside world, which have slowly but surely increased in size and dimension, she
has actually created a situation that makes it easier for him to continue -- and
progress -- in his downward spiral. Rather than help the alcoholic, and herself,
she has actually enabled him to get worse.
The heat increased so gradually, over such an extended period of time,
nobody noticed the water was beginning to boil and it was time to jump out of
the pan.
The disease will continue to progress for the alcoholic until he is ready to
reach out and get help for himself. Waiting for that to happen is not her only choice.
The other family members can begin to recover whether the alcoholic is still drinking or not.
But it can't happen until somebody picks up that telephone and asks for help. There is
hope and help out there.
Facts for
Families
Pages that help sort out the confusion.
Family &
Friends Support
Resources for those effected by someone else's drinking.
Denial
Enabling Etc.
Dynamics of the family disease.
For the
Children
Links for children in alcoholic homes.
Help
for Parents
Tips and information for all parents.
Teens &
Alcohol
Information about teenage drinking.
Nar-Anon
Resources
For the friends and families of drug addicts.
| The median age at which children begin drinking is just over thirteen years. |
| 26% of eighth graders, 40% of tenth graders, and 50% of twelfth graders report having used alcohol in the past month. |
| 18% of eighth graders, 38% of tenth graders, and 52% of twelfth graders report having been drunk at least once in the last year. |
| 28% of high school seniors reported in 1994 that they had consumed five or more drinks at one sitting during the preceding two weeks. |
| One-quarter of sixth graders say it is "fairly easy" or "very easy" to get beer. 15% say it is as easy to get liquor. One study conducted in Washington, DC reported that 19- and 20-year old males were able to purchase a six-pack of beer in 97 out of 100 attempts. |
| Purchase and public possession of alcohol by people under the age of 21 is illegal in all 50 states. |
| 56% of students in grades 5 to 12 say that alcohol advertising encourages them to drink. |
| Over 80 percent of adults surveyed by the Bureau of Alcohol, Tobacco, and Firearms in 1988 believed that alcohol advertising influences underage youth to drink alcoholic beverages. |
RISKS & CONSEQUENCES FOR YOUTH
| Among 9th-grade students, alcohol or other drug use, or a combination of substances, was the best predictor of early sexual activity and failure to use contraception. For youth, alcohol use more than any other single factor is responsible for more pregnancies, sexually transmitted diseases, and more HIV infections. |
| High-school students who drink are four times more likely to have had sexual intercourse and twice as likely to have had four or more sex partners than non-drinkers, behaviors which increase the risk for HIV infection. |
| More than 2.6 million students do not know that a person can die from an overdose of alcohol. |
| One-third of high school seniors do not recognize the consumption of four or five drinks nearly every day as entailing "great risk". |
| A projected 259,000 students think that wine coolers or beer cannot get a person drunk. |
| Drinking among young people puts them at greater risk than their peers for involvement in crime as either actors or victims. Alcohol use is connected to provoking assailants, acting vulnerable, and failing to take normal, common-sense precautions to avoid being victimized. |
| Alcohol use has been involved in as many as 50-65 percent of all suicides among youths. |
| Alcohol is a factor in the three leading causes of death for 15-24 year olds: accidents, homicides, and suicides. |
| In 1994, more than 4000 drivers aged 16-24 were involved in fatal crashes involving alcohol. |
| Alcohol use by college students is a factor in 40% of academic problems, 28% of dropouts, 80% of acts of vandalism. |
| 95% of violent crime on college campuses is alcohol-related. 90% of all reported campus rapes involve alcohol use by the victim or the perpetrator. |