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In the United States, an estimated 17.6 million American’s have a problem with misusing alcohol.  For the purpose of this discussion, alcoholism is defined as both alcohol abuse and alcohol dependence.  Alcohol abuse is the continued use of alcohol despite the awareness it causes problems in health, employment, personal relationships, and legally.  Alcohol dependence adds to the problems the element of tolerance. 

 There is no one cause for alcoholism.  There seems to be a blend of genetic, physical, psychological, environmental and social factors that influence individuals.  Alcoholism touches all socioeconomic groups.  Genetic influences are believed to account for about 60% of alcoholism risk.  Your risk of becoming alcoholic is 4-5X greater if you have an alcoholic parent.  The rate of alcohol problems increase with increased number of alcoholic relatives, severity of illness and closeness to the person in question.  Your risk is increased the earlier you start drinking.  Risk goes up by with male gender.  The lifetime risk of dependence for men is 10-15%, for women is 3-5%.   People with mental health issues are at increased risk of alcoholism, often using alcohol to self medicate.  Also, your risk for alcoholism goes up if you abuse other substances including:  tobacco, or prescription and illicit drugs. 

 Signs of alcohol abuse: 

You have problems at work or school such as tardiness, absenteeism, increased injuries, and decreased performance related to alcohol use.
You drink in dangerous situations, such as before or while driving a car.
You have blackouts- after a drinking episode, when sober, you can not remember what happened while drinking.
You have legal problems because of drinking.
You continue to drink despite health problems that are caused or made worse by alcohol use.
Your friends or family are worried about your drinking.

Signs of alcohol dependence or addiction:
You crave alcohol and are not able to control your drinking, even when you want to.
You have withdrawal symptoms such as nausea, sweating or anxiety when you cut back or stop drinking.
You must drink more alcohol to feel the same effects.
In spite of the signs, you think you don’t have a problem.
Friends or family members are worried about your drinking.
You have physical symptoms, such as blackouts.
You hide your drinking or how much you drink,
You are not comfortable in situations where alcohol is not served.

Diagnosis is made with a high index of suspicion.  The average alcoholic is male or female,     neatly groomed, has a job and family, and sometimes physical symptoms.  Only about 5%

of alcoholics are homeless.  While some alcoholics get very drunk, others give the appearance of coping with everyday affairs.  Physical ailments can include high blood pressure, chronic gastritis, pancreatitis, nutritional deficiencies, frequent bruising, and/or enlarged livers or cirrhosis.

Treatment

Chronic alcoholism is a progressive, fatal disease including cravings, tolerance, and loss of control over drinking.  Denial complicates the alcohol abusers ability to confront the addiction.  The continuous craving complicates the alcohol abusers ability to abstain.  It is important to realize addiction is characterized as a medical disorder not a lack of will or a character defect.  Treatment includes breaking the denial, increasing motivation for abstinence, and preventing relapse.  An important outlook if there is a regression to drinking is to consider it a trial and error and not an opportunity to return to regular drinking.  Support in the way of counseling and self help groups have been the mainstay of treatment.  AA helps give new abstainers a model of recovery. 

With the increase in research in alcohol abuse there have been new medications to help alleviate the suffering.  There are new medications that decrease the cravings and medications that help maintain abstinence.   

Prevention In our society prevention is a difficult thing.  Over 50% of teens have their first drink by age 14.  Laws and educational programs in the U.S. are designed to prevent alcohol abuse but there needs to be ongoing vigilance surrounding this addiction.

References:

www.webmd.com/mental-health/alcohol-abuse

www.ncadistore.samhsa.gov/catalog/facts’ I/S/ Department of Health & Human Service and SAMHSA’s National Clearinghouse for Alcohol and Drug Information

www.niaaa.nih.gov/pubications/handout.htm; National Institute on Alcohol Abuse and Alcoholism Kaplan and Saddock; Comprehensive Textbook of Psychiatry, Eighth Edition, Alcohol Related Disorders.