Alcoholism

VII

Health Consequences

While some studies have found that moderate use of alcohol has beneficial health effects, including protection from coronary heart disease, heavy and prolonged intake of alcohol can seriously disturb body chemistry. Heavy drinkers lose their appetite and tend to obtain calories from alcohol rather than from ordinary foods. Alcohol is rich in calories and can provide substantial amounts of energy. However, if it constitutes the primary source of calories in place of food, the body will lack vitamins, minerals, and other essential nutrients.

Prolonged use of large amounts of alcohol may cause serious liver damage. In the first stage of liver disease caused by alcohol, fat accumulates in the liver. This stage of the disease is known as fatty liver. Most people do not notice symptoms of fatty liver, although in some people the liver becomes enlarged and tender. Some people with fatty liver develop hepatitis, which inflames and kills liver cells. Hepatitis is marked by jaundice, which gives a yellowish tint to the eyes and skin. Others may develop cirrhosis, an irreversible condition in which normal liver tissue is replaced by scar tissue. The scarring prevents blood from traveling freely through the liver, building blood pressure in the veins that run from the intestine to the liver. Consequently, the liver can no longer process toxins efficiently, causing poisons to build up in the blood. This buildup can be fatal.

Heavy drinking also damages heart muscle. Nearly half of all cases of cardiomyopathy are caused by alcohol abuse. In this heart disease, the heart muscles, particularly the right and left ventricles, enlarge and become flabby, reducing the heart’s blood-pumping efficiency. This inefficiency reduces the flow of blood through the kidneys, which normally filter excess salts and water out of the blood. Eventually the blood volume rises, causing a potentially fatal backup of fluid in the lungs.

Alcoholics tend to have high blood levels of the hormone epinephrine and deficiencies of the mineral magnesium. This combination produces severe arrhythmias, or heartbeat irregularities, a common cause of sudden death in heavy drinkers. Chronic drinkers typically develop hypertension, a leading cause of stroke.

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In some cases, alcohol withdrawal may lead to delirium tremens (DTs), which produces increasing confusion, sleeplessness, depression, and terrifying hallucinations. As this delirium progresses, the hands develop a persistent and uncontrollable shaking that may extend to the head and body.

Women who drink excessive amounts of alcohol while pregnant run a high risk of having a baby born with fetal alcohol syndrome (FAS), the leading known cause of birth defects. FAS results in a combination of mental and physical defects, such as retardation, a small head, and poor muscle tone. Some babies exposed to alcohol during fetal maturation develop fetal alcohol effect (FAE), which produces more subtle symptoms, including behavioral problems, difficulty paying attention, or the inability to think abstractly.

VIII

Treatment of Alcohol Dependence

The best methods to treat alcohol dependency vary, depending upon an individual’s medical and personal needs. Some heavy drinkers who recognize their problem appear to recover on their own. Others recover through participation in the programs of Alcoholics Anonymous or other self-help groups. Some alcoholics require long-term individual or group therapy, which may include hospitalization. And still others do not seek treatment at all. These people do not seek treatment as the result of a combination of factors, including ignorance of the symptoms of alcohol-use disorders, the social stigma that still surrounds these disorders—that is, the fear of being labeled an alcoholic—and an unwillingness to accept lifetime abstinence from alcohol as a treatment goal.

Numerous studies indicate that simple, brief interventions can be effective in changing drinking behavior in those who are not severely alcohol dependent. In brief interventions, a problem drinker meets with a health professional for one to four sessions, with each session lasting from a few minutes to an hour. During these meetings, the health professional makes the person aware that his or her current drinking patterns or medical problems are related to alcohol abuse and could progress to alcohol dependence. Using a warm, reflective, and understanding style of delivery, the health professional employs a variety of strategies to encourage the individual to change his or her drinking behavior. The goal of brief interventions typically is to help people moderate their drinking rather than resort to complete abstinence. Brief interventions also have been used to motivate alcoholics to enter specialized treatment programs and work toward complete abstinence from alcohol.

For some alcoholics, treatment begins with detoxification, which safely rids the patient’s body of alcohol while treating any physical complications that develop from severe withdrawal symptoms, such as delirium tremens. Detoxification normally requires less than a week, during which time patients usually stay in a specialized residential treatment facility or a separate unit within a general or psychiatric hospital. These facilities also offer extended treatment programs to help alcoholics in their recovery effort.

Recovery also may involve individual counseling and group therapy to help a person who is alcohol dependent adapt to a new way of life, one that is not driven by alcohol. Throughout the United States and Canada, public outpatient and inpatient clinics offer a variety of treatments for alcoholics. The National Council on Alcoholism and Drug Dependence (NCADD) has affiliates in many cities that help people who are alcohol dependent find appropriate treatment programs. Many public mental hospitals and Veterans Administration hospitals, as well as private clinics and hospitals, treat alcohol dependence.

Physicians may prescribe medications to help prevent alcoholics from returning to drinking once they have stopped. The drug disulfiram (sold under the trade name Antabuse), interferes with the way the body processes alcohol. Taken in pill form daily, this medication generally has no noticeable effects until a person drinks alcohol. The alcohol and drug interact to produce an extremely unpleasant reaction, including nausea, dizziness, headache, heart palpitations, and other problems. Alcoholics then associate illness with drinking and, in many cases, avoid alcohol use. Naltrexone (ReVia) is a narcotic approved for use in alcohol treatment in 1995. Although scientists are not certain how this medication works in the brain, it reduces an alcoholic’s craving for alcohol, most likely by blocking the positive effects the individual gets from drinking alcohol. Naltrexone is most effective when it is used in combination with counseling programs. Acamprosate (trade name, Campral) is used to help alcoholics maintain abstinence once they have ceased drinking. Scientists believe it works by restoring balance among the chemicals that enable brain cells to communicate with one another. Alcohol dependence disrupts this balance.

Most treatment programs effectively help alcohol-dependent persons stop drinking for a period, but they are less successful in preventing a subsequent return to drinking. Treatment programs typically contain a component that focuses on helping alcoholics understand the situations, feelings, and interpersonal interactions that trigger drinking. These programs teach people how to cope with these factors without returning to drinking.

In addition to formal treatment programs, other widely available community resources include vocational rehabilitation, family guidance, and religious counseling. Many countries, including Poland, Finland, and South Africa, and some U.S. states have compulsory treatment programs for alcoholics who have committed crimes. Mutual-help organizations, such as Alcoholics Anonymous and Rational Recovery, provide a free and effective method to cope with recovery.

A

Alcoholics Anonymous

Until the mid-1930s, alcohol-dependent individuals who could not afford a private sanitarium or psychiatrist could find help only at state hospitals, in jails, or through street ministries. The formation of Alcoholics Anonymous (A.A.) in 1935 marked the first nonmedical approach that made sustained recovery from alcohol dependence possible for many individuals.

The A.A. program promotes psychological principles that help people live a healthy, stress-free lifestyle. The organization functions through local groups that have no constitutions, officers, or dues. Anyone who has a drinking problem may become a member, provided he or she is willing to abstain from alcohol and make an honest attempt to live by the principles outlined by the organization.

In A.A. meetings the individual learns that he or she suffers from a disease. Any feelings of unworthiness the individual feels are dispelled by supportive group interaction. A.A. offers a twelve-step program to recovery. The twelve-step program confronts the problem of denial by urging alcoholics to admit that their drinking has made their lives unmanageable. The program also calls for alcoholics to atone for the harm caused by their alcoholism, to commit themselves to live ethically and spread the A.A. message to others, and to rely on a higher power greater than their own will. Mutual help groups for family members of alcoholics include Alateen, which serves teenagers, and Adult Children of Alcoholics. Al-Anon is a mutual help group open to friends and family of alcoholics (see Al-Anon Family Groups).

B

Other Recovery Approaches

While Alcoholics Anonymous is widely recognized as an effective source of support, not everyone responds to the group’s spiritual bent. Other recovery approaches include national organizations such as Rational Recovery and Secular Organizations for Sobriety/Save Our Selves (SOS).

Rational Recovery was developed in 1986 for people who find the A.A. approach unappealing. Rational Recovery promotes lifelong abstinence from alcohol and teaches people how to recognize what is called an addictive voice, the thoughts and feelings that promote alcohol use. By identifying the addictive voice and separating from it, people seeking to avoid alcohol can learn to avoid the actions the addictive voice instigates.

Secular Organizations for Sobriety/Save Our Selves (SOS) uses peer-group support to promote abstinence. In these support sessions, recovery is separated from spirituality—individuals are encouraged to rely on themselves and others in the group, not a spiritual power, to gain sobriety. LifeRing is another organization that uses support groups and a secular philosophy to help people overcome their problems with alcohol.

IX

Prevention of Alcohol Dependence

A concerted effort by many public health organizations may in time enable society to readily identify early signs of problem drinking and encourage people to accept early intervention before the condition worsens. Many agencies seek to improve public understanding about this illness, including the NIAAA, the Substance Abuse and Mental Health Services Administration, the National Clearinghouse on Alcohol and Drug Information, Health Canada, and the Canadian Center on Substance Abuse. Advertising campaigns, newspaper articles, feature stories in magazines, and motion picture and television presentations that call attention to the problem help lessen any social stigma still attached to the disease. Schools and colleges sponsor programs that help students to recognize the symptoms of alcohol dependence and to know how to get help when drinking becomes a problem. As the public becomes more aware of the health and social consequences of the disease, the incidence of alcohol dependence may decrease, and earlier and better treatments may lead to higher recovery rates.

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