Alcoholism

I

Introduction

Alcoholism or Alcohol Dependence, chronic disease marked by a craving for alcohol. People who suffer from this illness are known as alcoholics. They cannot control their drinking even when it becomes the underlying cause of serious harm, including medical disorders, marital difficulties, job loss, or automobile crashes. Medical science has yet to identify the exact cause of alcoholism, but research suggests that genetic, psychological, and social factors influence its development. Alcoholism cannot be cured yet, but various treatment options can help an alcoholic avoid drinking and regain a healthy life.

People tend to equate any kind of excessive drinking with alcoholism. But doctors and scientists recognize that disorders related to alcohol use lie along a continuum of severity. They prefer to use the term alcohol dependence instead of alcoholism to designate the most severe of the alcohol-use disorders. The terms alcohol abuse and problem drinking designate less severe disorders resulting from immoderate drinking.

Alcohol dependence develops differently in each individual. But certain symptoms characterize the illness, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), a United States government agency that is part of the National Institutes of Health. Alcoholics develop a craving, or a strong urge, to drink despite awareness that drinking is creating problems in their lives. They suffer from impaired control, an inability to stop drinking once they have begun. Alcoholics also become physically dependent on alcohol. When they stop drinking after a period of heavy alcohol use, they suffer unpleasant physical ailments, known as withdrawal symptoms, that include nausea, sweating, shakiness, and anxiety (see Drug Dependence). Alcoholics develop a greater tolerance for alcohol—that is, they need to drink increasing amounts of alcohol to reach intoxication. The World Health Organization (WHO) notes that other behaviors common in people who are alcohol dependent include seeking out opportunities to drink alcoholic beverages—often to the exclusion of other activities—and rapidly returning to established drinking patterns following periods of abstinence.

II

Prevalence

Alcohol dependence affects a broad cross section of society around the world. Statistics show that alcohol dependence touches successful business executives, skilled mechanics, laborers, homemakers, and church members of all denominations. Scientists have not identified a typical alcoholic personality, and they cannot predict with absolute certainty which drinkers will progress to alcohol dependence.

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Alcohol use varies depending on an individual’s social, cultural, or religious background. Some individuals do not drink at all—about one-third of adults in the United States who are 18 and older, for example, abstain from alcohol. Others drink as part of social custom. Still others drink frequently and in substantial amounts. Those suffering from alcohol dependence drink to appease an uncontrolled craving for alcohol or to avoid experiencing the unpleasant symptoms of withdrawal.

WHO estimates that about 76 million people worldwide suffer from alcohol-related disorders. The prevalence of the illness varies in different countries. In the United States about 15 percent of the population experiences problems related to their use of alcohol. Of these, alcohol dependence affects about 12.5 million men and women, or almost 4 percent of the population. Men are three times more likely than women to become alcoholics, while people aged 65 and older have the lowest rates of alcohol dependence.

In the United States, people who start to drink at an early age are at particular risk for developing alcohol dependence. Estimates indicate that 40 percent of people who begin to drink before age 15 will become alcohol dependent at some point in their lives. These individuals are four times more likely to become alcohol dependent than those who delay drinking until age 21.

In Canada, an estimated 4 percent of the people aged 15 and older are alcohol dependent, and the number of male alcoholics is double that of females. The highest rate of this illness occurs in Canadians between the ages of 20 and 24. In Canadian surveys about one in five current and former drinkers admit that their drinking harmed them at some point in their lives, affecting their jobs or financial position.

Alcohol dependence has reached critical proportions in Russia, where it is estimated that almost a third of all deaths are related, directly or indirectly, to alcohol abuse. Periodic efforts by the government to control drinking by closing distilleries, breweries, and bars have backfired. Instead of solving the problem, such tactics only created a widespread black market for liquor—as well as a country of people who hide their drinking problems.

In Asian nations such as Japan, alcohol abuse has become a social concern. In these countries, drinking almost is required when conducting business. Bars are an extension of offices, places where key decisions are made. A person who declines an invitation to a drink after work risks being passed over for promotion within the company. Alcohol is readily available in Japan—vending machines along the streets of Tokyo dispense cans of beer and sake.

III

Physical Effects of Alcohol

Ethyl alcohol, or ethanol, is present in varying amounts in beers and wines, and in distilled liquors such as whiskey, gin, and rum. When a person consumes alcohol, the stomach and intestines rapidly absorb it. From there alcohol travels in the blood throughout the entire body, affecting nearly every tissue. Moderate and high doses of alcohol depress the functions of the central nervous system, including the brain. The higher the alcohol level is in the blood, the greater the impairment.

As blood passes through the liver, enzymes break down alcohol into harmless byproducts, which are eliminated from the body six to eight hours later. But the rate at which alcohol accumulates in the body may be faster than the rate at which the body eliminates it, resulting in rising alcohol levels in the blood. Consequently, alcohol remains in the body, producing intoxicating effects hours after the last drink was swallowed.

Small amounts of alcohol may relieve tension or fatigue, increase appetite, or produce an anesthetic affect that numbs pain. Larger quantities inhibit or depress higher thought processes, bolstering self-confidence and reducing inhibition, anxiety, and guilt. As a person becomes intoxicated, painful or embarrassing situations appear less threatening and, as drinking progresses, speech may become loud and slurred. Impaired judgment may lead to incautious behavior, and physical reflexes and muscular coordination may become noticeably affected. If drinking continues, complete loss of physical control follows, ending in stupor, and possibly death.

IV

Social Effects of Alcoholism

Throughout most of history, society has viewed people who drink to excess as irresponsible, immoral, and of weak character. Punishment of drunkards was considered necessary to protect the community. By the early 1900s, experts conceded that alcohol dependence may result from tissue changes caused by the action of alcohol. These changes produce a continued need to drink, such that the individual seeks larger amounts of alcohol at more frequent intervals. However, society still regarded taking or rejecting a drink as a matter of personal decision, thus all excessive drinking was considered a voluntary act. The individual, therefore, was held responsible for his or her behavior.

Although a consensus is growing among health professionals that alcohol dependence is a disease, society’s attitudes toward individuals with drinking problems remain ambivalent and confused. Until the mid-20th century, the typical picture of the alcoholic was of someone without steady employment, unable to sustain family relationships and most likely in desperate financial straits. But this stereotype was largely dispelled when highly respected people publicly admitted their alcohol dependence and shared their successful recovery stories. Particularly critical in changing the way Americans view alcohol-use disorders were New York broker William Griffith Wilson (more familiarly known as Bill W.) and Ohio physician Robert Holbrook Smith (Dr. Bob). In 1935 these two recovered alcoholics developed a program to promote their successful philosophy for recovering from alcohol dependence. The program, which became known as Alcoholics Anonymous, has spread around the world, helping millions of members to avoid alcohol use and rebuild their lives. In the late 1970s Betty Ford, the wife of former U.S. president Gerald Ford, disclosed her struggle to recover from alcohol dependence. She helped raise the public’s understanding about alcohol dependence through her open, honest revelations and her creation of a groundbreaking treatment center for substance abusers in Rancho Mirage, California, now known as the Betty Ford Center.

Intoxication threatens not only the individual who drinks but also the surrounding community. Therefore, societies around the world have attempted to control excessive use of alcohol. Temperance societies in the 19th and 20th centuries pushed for laws ranging from arrest and jail sentences for public drunkenness to prohibition of the manufacture, distribution, and consumption of alcoholic beverages.

Today experts characterize alcohol-use disorders as a form of illness, and one so widespread that it constitutes a major public health problem. According to WHO, alcohol dependence and other alcohol-use disorders undermine global health, accounting for 3.5 percent of the total cases of disease worldwide. This figure equals the hazards posed by unsafe sex and surpasses two other formidable health foes, tobacco and illicit drugs. In the United States alone, the NIAAA estimates that alcoholism causes losses of more than $185 billion a year in lost productivity, illness, and premature death.

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