Questions About Alcoholism
It is important to understand that these answers are not meant to provide specific medical advice, but to provide
information to better understand the health consequences of alcohol abuse and dependence (alcoholism).
Please consult your physician or other health care provider if you or a loved one has an alcohol problem.
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 has also 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 "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 "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 are also 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 "Publications,"
A Family History of Alcoholism - Are You at Risk?;
Alcohol Alert No. 18:
The Genetics of Alcoholism.)
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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.
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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
"Publication,"
Alcohol Alert No. 49: New Advances in Alcoholism Treatment.)
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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 "News Releases," Jan. 17, 1995:
Naltrexone Approved for Alcoholism Treatment and "Publication,"
Alcohol Alert No. 61: Neuroscience
Research and Therapeutic Targets.)
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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.
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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, 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.
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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 1 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 "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.)
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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.
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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 "Publications/Pamphlets and Brochures,"
How to Cut Down on Your Drinking.)
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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. (See the question
19, "How can a
person get help for an alcohol problem?" for referral to support groups.)
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.
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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, such as:
• 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 "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.)
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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 "Publications"
Alcohol Alert No. 50: Fetal Alcohol Syndrome and the Brain; "Pamphlets and Brochures,"
Drinking and Your Pregnancy.)
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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
"Publications/Pamphlets and Brochures"
Age Page: Alcohol Use and Abuse.)
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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. (See the question
13, "What is a safe level of drinking?" for recommended limits.)
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 "Publications,"
Alcohol Alert No. 62: Alcohol-An Important Women's Health Issue.)
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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 "Publications,"
Alcohol Alert No 16: Moderate Drinking and
Alcohol Alert No. 45: Alcohol Coronary Heart Disease.)
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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 "Publications,"
Harmful Interactions; Mixing Alcohol with Medicines;
Alcohol Alert No. 27: Alcohol-Medication Interactions.)
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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).
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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)
Updated: February 2007
Source: National Institute on Alcohol Abuse and Alcoholism (NIAAA).
http://www.niaaa.nih.gov
Check out our
Find Help section for more resources.
