Chapter 2 – Understanding Alcoholism
Definition of Alcoholism
In a public policy statement issued in late 2011, the American Society of Addiction Medicine (ASAM) defined alcoholism in the following terms:
“Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic:
- impaired control over drinking
- preoccupation with the drug alcohol
- use of alcohol despite adverse consequences
- distortions in thinking, most notably denial”
To clarify, ASAM explains that alcoholism is a primary and chronic disease—meaning alcoholic addiction is not a symptom of any underlying disease and that it is, in essence, an involuntary disability associated with a common set of characteristics. Additionally, alcoholism is viewed as being progressive and fatal because the condition persists over time and the physical, emotional, and social changes that occur are often cumulative.
Those who are alcoholic are unable to limit their consumption. Because of this, alcoholics have a preoccupation with drinking alcohol and obtaining alcoholic beverages, to the point that they experience adverse consequences. These consequences are pronounced in areas such as physical health, psychological stability, interpersonal relations, and occupational skills, along with legal, financial, and spiritual problems. Finally, alcoholics are often in denial, using a wide range of psychological maneuvers to rationalize their drinking and minimize the severity of their ensuing problems.
Alcohol is the number one drug problem in the United States. Each day, Americans spend approximately $197 million dollars on alcohol purchases. In 2006, the Centers for Disease Control estimated that alcohol abuse cost the United States $223.5 billion, with each state losing approximately $2.9 billion in expenses.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) released the following statistics concerning alcohol consumption:
- In 2014, 87.6 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime; 71.0 percent reported that they drank in the past year; 56.9 percent reported that they drank in the past month.
- In 2014, 24.7 percent of people ages 18 or older reported that they engaged in binge drinking in the past month (drinking 5 or more alcoholic drinks on the same occasion, on at least 1 day in the past 30 days); 6.7 percent reported that they engaged in heavy drinking in the past month (drinking 5 or more drinks on the same occasion, on each of 5 or more days in the past 30 days).
- An estimated 17 million Americans have an alcohol use disorder (AUD)—a medical term that includes alcoholism, as well as harmful drinking that does not reach the level of dependence. Only an estimated 15% of the individuals with an AUD will seek treatment.
- Each year in the U.S., nearly 88,000 people die from alcohol-related causes, making it the fourth leading preventable cause of death in the United States. Additionally, liver cirrhosis—a common and serious condition associated with alcohol abuse and alcoholism—was listed as the 12th leading cause of death in the United States in 2009. Of those cirrhosis deaths, nearly half (48.2%) were alcohol related
Withdrawal Symptoms & Consequences
Like any other substance that can be abused, alcohol has a unique set of withdrawal symptoms and consequences associated with long-term abuse. The more a person drinks regularly, the more likely he or she is to develop withdrawal symptoms when they stop drinking. Withdrawal from alcohol can be extremely dangerous in many ways—withdrawal can keep a heavy-drinker in a cycle of using in order to manage their symptoms, or the withdrawal symptoms can cause severe, even fatal, physical consequences.
According to the U.S. National Institutes of Health, the most common, mild symptoms are:
- Anxiety, nervousness
- Jumpiness or shakiness
- Depression, fatigue
- Mood swings
- Not thinking clearly
As symptoms progress, a more moderate withdrawal can also look like:
- Headache, loss of appetite, clammy skin
- Enlarged (dilated) pupils
- Insomnia (sleeping difficulty)
- Nausea and vomiting
- Rapid heart rate, sweating
- Pallor (paleness)
- Tremor of the hands or other body parts
The most severe form of alcohol withdrawal is called delirium tremens, which is characterized by severe tremors in a heavy alcohol abuser’s body, as well as severe mental and nervous system changes. A person experiencing delirium tremens needs medical attention and detoxification in order to prevent life-long damage to their body.
Delirium tremens (DTs) is most common in drinkers who consume upwards of 4 pints of wine, 7 pints of beer, or 1 pint of “hard” alcohol every day for several months, as well as in people who have used alcohol for 10 years or more. Symptom usually arise within 48-96 hours after the last drink, but can still occur 7-10 days after the last drink. Beyond intense body tremors, the most common symptoms of delirium tremens are:
- Agitation, irritability
- Fever, delirium, stupor
- Hallucinations, fear, intense mood swings
- Severe confusion
- Sleepiness, long periods of deep sleep
Medical attention is important to relieve these symptoms, prevent as many complications as possible, and, ultimately, save the person’s life. A hospital stay is needed to monitor a person’s vital signs, and medication can help sedate a patient until the DTs pass and their detoxification process continues. Without medical aid, a person experiencing DTs and detoxing on their own can suffer from serious injuries in the midst of delirium, life-threatening complications with an irregular heartbeat, and possible brain damage from seizures.
Risk Factors Associated With Alcoholism
The development of alcoholism in an individual occurs gradually over time, and there are many factors that contribute to its onset and progression. The following is a list of the major risk factors that need to be taken into consideration for their potentiality to lead to alcoholism:
Alcohol use, abuse, and addiction among young people has consistently been a significant concern. More youth in the United States drink alcohol than smoke tobacco or marijuana, making it the drug most used by American young people.
It is estimated that approximately half of all Americans under the age of 21 have used alcohol. It is estimated that about 2 million young people aged are considered heavy drinkers and 4.4 million have engaged in binge drinking. Every day in the United States, more than 4,750 kids under age 16 have their first full drink of alcohol.
The earlier a person begins drinking, the greater their potential for developing alcohol dependence and abuse issues. In the 12-17 age group, the average age a young person begins to drink is 13 years of age. The average age for first-time use among boys is age 11, while in girls the average age is 13. In regards to the development of alcohol abuse, additional risk factors seen in young people include a family history of alcoholism or addiction, past abuse, family violence, and depression, along with other environmental stresses.
Alcohol use and abuse are also a serious, growing problem among college students.
On many college and university campuses, there is an undeniable culture of partying that is extremely normalized and almost expected. There is even a list ranking the top “party schools” in the United States that is updated annually. Despite the fact that most college students are not of legal drinking age, about 4 out of 5 college students drink alcohol—half of which regularly binge drink, meaning they consume 5 or more drinks in a row.
Alcohol intoxication is particularly dangerous in college students because, for most of them, it is their first time living on their own with increased freedom, added peer pressure, and a lack of experience with alcohol consumption and how it effects their body. This can result in careless, reckless behavior, contributing to the 1,825 college students who die each year due to alcohol-related injuries. Alcohol use also has a significant association with severe problems like sexual abuse and assault on college campuses. Because partying and regular binge drinking are considered “normal” behaviors at this stage in life, it becomes much more difficult to recognize what could be the early stages of alcoholism.
There are also specific risk factors seen in both older adults (aged 40-65) and the elderly (aged 65 and older). Because of the natural aging process, the outward manifestations of alcohol abuse and alcoholism may not always be noticeable. For those over the age of 65, there are age-related body changes that make this age group more vulnerable if alcohol is abused:
- Decrease in body’s water levels
- Increased sensitivity and decreased tolerance to alcohol
- Decrease in the metabolism of alcohol in the gastrointestinal tract
As lean body mass decreases with age, the body’s total water content also decreases while fat increases. Because alcohol is water-soluble and not fat-soluble, this change means that, for a given dose of alcohol, the concentration of alcohol in the blood system is greater in an older person than it would be in a younger person. Therefore, the result is an increased sensitivity and decreased tolerance to alcohol as people age. For this reason, the same amount of alcohol that previously had little effect on a person can now cause serious damage. This also means an elderly person may seem to drink less, making their alcoholism difficult to discern. It is important to note those who abuse alcohol aren’t necessarily alcoholics; however, such abuse is a concrete risk factor.
Men are more likely than women to drink excessively, and ultimately develop an alcohol addiction. In March of 2016, 58% of adult men reported drinking alcohol in the last 30 days, and men are almost two times as likely to engage in binge drinking as women. Men who abuse alcohol have consistently higher rates of hospitalizations and alcohol-related deaths when compared to women. While those who engage in binge drinking may not necessarily be alcohol dependent or alcoholic, continued and excessive usage patterns, along with other factors, can increase the potential for alcoholism.
While alcoholism is seen more among men, the rate of women who are alcoholic has been increasing over the past three decades. In a report that was published in the New York Times, the CDC reported approximately 17% of men and 8% of women met the criteria for alcohol dependence issues at some point in their life. Women are increasingly at risk for developing alcoholism and similar alcohol abuse disorders due to differences in body size. Women are also more likely than men to develop alcoholic hepatitis, and more likely to die due to cirrhosis of the liver. Although men who abuse alcohol have higher rates of hospitalizations and deaths, there are unique risks women face when they binge drink:
Interestingly, another proposed explanation for the surge in the number of women with alcoholism or alcohol abuse issues is the increasing presence of women in the workforce, especially in the white-collar sector. With women becoming more upwardly mobile and holding white-collar positions, the social dynamic that is part of that lifestyle—including social drinking—becomes more normative. Additionally, the added stress and social pressure that come with these jobs have the potential to lead to alcohol dependence and abuse patterns and behaviors, leading up to alcoholism.
Abuse and Family History
Individuals who were abused as children have a higher risk of developing substance abuse later in life. This abuse can be sexual, physical, or mental. Oftentimes, if the parents themselves abused alcohol and/or drugs, the potential for their children to develop alcohol abuse and other substance abuse issues increase. Having a parent who is or was addicted to alcohol increases your likelihood of becoming dependent upon alcohol. However, having a family history of alcoholism does not guarantee a child will develop the same problem eventually. In that same light, the absence of a family history of alcohol dependence does not always protect a child from developing an addiction later in life.
Race and Ethnicity
Overall, there are no discernible differences in the prevalence of alcoholism among African-Americans, Caucasians, and Hispanic-Americans. However, some population groups, such as Native Americans, have an increased incidence of alcoholism. Others, such as Jewish and Asian Americans, have a lower risk. Certain people in these various population groups may have a genetic susceptibility or invulnerability to alcoholism because of the way their bodies metabolize alcohol. The family dynamics and different cultural views on alcohol use also influence these patterns.
Mental Illness: Psychiatric and Behavioral Disorders
Depressed or anxious people, especially those who have symptoms severe enough to be diagnosed with a psychiatric disorder, are at high risk for alcoholism and addiction issues with other substances. A large proportion of people who are alcoholic also suffer from a co-existing psychiatric or substance abuse disorder. Disorders such as anxiety or depression may increase the risk for alcohol abuse and alcoholism. Depression is the most common psychiatric problem in people with alcoholism or substance abuse. Additionally, people with either bipolar disorder or schizophrenia also have an increased risk for developing substance abuse problems, including alcoholism.
Social phobia disorders as well as panic disorders may also increase the risk for alcohol and substance abuse. Social phobia disorders cause intense fear of being publicly scrutinized and humiliated, while panic disorders cause intense anxiety and panic attacks. With these disorders, the use of alcohol becomes a way to ease those anxieties and to lessen the feelings of panic. Long-term alcoholism itself may in turn cause chemical changes that produce anxiety and depression.
Children with the behavior disorder that is known as attention deficit hyperactivity disorder (ADHD) have higher risks of developing alcoholism in adulthood. Studies indicate that alcoholism is strongly related to impulsive, excitable, and novelty-seeking behavior, and such patterns are established early on. The risk is especially high in children with ADHD and a co-existing conduct disorder.
Generally, it is important to be aware of any mental illness or psychiatric disorder that you or a loved one may suffer from, because it may lead to substance abuse as an attempt to self-medicate the symptoms of illness. This doesn’t at all mean that every person living with a mental illness will turn to substances. However, substance abuse can actually amplify the symptoms of many mental illnesses and add additional challenges to daily living.