people, the facts about alcoholism are not clear. What is
alcoholism, exactly? How does it differ from alcohol abuse? When
should a person seek help for a problem related to his or her
drinking? The National Institute on Alcohol Abuse and Alcoholism
(NIAAA) has prepared this booklet to help individuals and families
answer these and other common questions about alcohol problems. The
following information explains both alcoholism and alcohol abuse,
the symptoms of each, when and where to seek help, treatment
choices, and additional helpful resources.
A Widespread Problem
people who drink, alcohol is a pleasant accompaniment to social
activities. Moderate alcohol use-up to two drinks per day for men
and one drink per day for women and older people-is not harmful for
most adults. (A standard drink is one 12-ounce bottle or can of
either beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces
of 80-proof distilled spirits.) Nonetheless, a large number of
people get into serious trouble because of their drinking.
Currently, nearly 14 million Americans-1 in every 13 adults-abuse
alcohol or are alcoholic. Several million more adults engage in
risky drinking that could lead to alcohol problems. These patterns
include binge drinking and heavy drinking on a regular basis. In
addition, 53 percent of men and women in the United States report
that one or more of their close relatives have a drinking
consequences of alcohol misuse are serious-in many cases, life
threatening. Heavy drinking can increase the risk for certain
cancers, especially those of the liver, esophagus, throat, and
larynx (voice box). Heavy drinking can also cause liver cirrhosis,
immune system problems, brain damage, and harm to the fetus during
pregnancy. In addition, drinking increases the risk of death from
automobile crashes as well as recreational and on-the-job injuries.
Furthermore, both homicides and suicides are more likely to be
committed by persons who have been drinking. In purely economic
terms, alcohol-related problems cost society approximately $185
billion per year. In human terms, the costs cannot be calculated.
Alcoholism, also known as
"alcohol dependence," is a disease that includes four
A strong need, or compulsion, to drink.
- Loss of control: The inability to limit one's drinking on any given
- Physical dependence: Withdrawal symptoms, such as nausea, sweating,
shakiness, and anxiety, occur when alcohol use is stopped after a
period of heavy drinking.
- Tolerance: The need to drink greater amounts of alcohol in
order to "get high."
People who are not
alcoholic sometimes do not understand why an alcoholic can't just
"use a little willpower" to stop drinking. However, alcoholism has
little to do with willpower. Alcoholics are in the grip of a
powerful "craving," or uncontrollable need, for alcohol that
overrides their ability to stop drinking. This need can be as strong
as the need for food or
some people are able to recover from alcoholism without help, the
majority of alcoholics need assistance. With treatment and support,
many individuals are able to stop drinking and rebuild their
What Is Alcohol Abuse?
abuse differs from alcoholism in that it does not include an
extremely strong craving for alcohol, loss of control over drinking,
or physical dependence. Alcohol abuse is defined as a pattern of
drinking that results in one or more of the following situations
within a 12-month period:
- Failure to
fulfill major work, school, or home responsibilities;
- Drinking in
situations that are physically dangerous, such as while driving a
car or operating machinery;
- Having recurring
alcohol-related legal problems, such as being arrested for driving
under the influence of alcohol or for physically hurting someone
while drunk; and
drinking despite having ongoing relationship problems that are
caused or worsened by the drinking.
alcohol abuse is basically different from alcoholism, many effects
of alcohol abuse are also experienced by alcoholics.
you tell whether you may have a drinking problem? Answering the
following four questions can help you find out:
- 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 (as an "eye opener") to
steady your nerves or get rid of a hangover?
answer suggests a possible alcohol problem. If you answered "yes" to
more than one question, it is highly likely that a problem exists.
In either case, it is important that you see your doctor or other
health care provider right away to discuss your answers to these
questions. He or she can help you determine whether you have a
drinking problem and, if so, recommend the best course of
you answered "no" to all of the above questions, if you encounter
drinking-related problems with your job, relationships, health, or
the law, you should seek professional help. The effects of alcohol
abuse can be extremely serious-even fatal-both to you and to
the fact that help is needed for an alcohol problem may not be easy.
But keep in mind that the sooner you get help, the better are your
chances for a successful recovery.
concerns you may have about discussing drinking-related problems
with your health care provider may stem from common misconceptions
about alcoholism and alcoholic people. In our society, the myth
prevails that an alcohol problem is a sign of moral weakness. As a
result, you may feel that to seek help is to admit some type of
shameful defect in yourself. In fact, alcoholism is a disease that
is no more a sign of weakness than is asthma. Moreover, taking steps
to identify a possible drinking problem has an enormous payoff-a
chance for a healthier, more rewarding life.
visit your health care provider, he or she will ask you a number of
questions about your alcohol use to determine whether you are having
problems related to your drinking. Try to answer these questions as
fully and honestly as you can. You also will be given a physical
examination. If your health care provider concludes that you may be
dependent on alcohol, he or she may recommend that you see a
specialist in treating alcoholism. You should be involved in any
referral decisions and have all treatment choices explained to you.
of treatment you receive depends on the severity of your alcoholism
and the resources that are available in your community. Treatment
may include detoxification (the process of safely getting alcohol
out of your system); taking doctor-prescribed medications, such as
disulfiram (Antabuse®) or naltrexone (ReVia™),
to help prevent a return (or relapse) to drinking once drinking has
stopped; and individual and/or group counseling. There are promising
types of counseling that teach alcoholics to identify situations and
feelings that trigger the urge to drink and to find new ways to cope
that do not include alcohol use. These treatments are often provided
on an outpatient basis.
the support of family members is important to the recovery process,
many programs also offer brief marital counseling and family therapy
as part of the treatment process. Programs may also link individuals
with vital community resources, such as legal assistance, job
training, childcare, and parenting classes.
all alcoholism treatment programs also include Alcoholics Anonymous
(AA) meetings. AA describes itself as a "worldwide fellowship of men
and women who help each other to stay sober." Although AA is
generally recognized as an effective mutual help program for
recovering alcoholics, not everyone responds to AA's style or
message, and other recovery approaches are available. Even people
who are helped by AA usually find that AA works best in combination
with other forms of treatment, including counseling and medical
Can Alcoholism Be Cured?
alcoholism can be treated, a cure is not yet available. In other
words, even if an alcoholic has been sober for a long time and has
regained health, he or she remains susceptible to relapse and must
continue to avoid all alcoholic beverages. "Cutting down" on
drinking doesn't work; cutting out alcohol is necessary for a
even individuals who are determined to stay sober may suffer one or
several "slips," or relapses, before achieving long-term sobriety.
Relapses are very common and do not mean that a person has failed or
cannot recover from alcoholism. Keep in mind, too, that every day
that a recovering alcoholic has stayed sober prior to a relapse is
extremely valuable time, both to the individual and to his or her
family. If a relapse occurs, it is very important to try to stop
drinking once again and to get whatever additional support you need
to abstain from drinking.
health care provider determines that you are not alcohol dependent
but are nonetheless involved in a pattern of alcohol abuse, he or
she can help you to:
- Examine the benefits of stopping an unhealthy drinking pattern.
- Set a drinking goal for yourself. Some people choose to abstain from alcohol.
Others prefer to limit the amount they drink.
- Examine the situations that trigger your unhealthy drinking patterns, and
develop new ways of handling those situations so that you can maintain your drinking goal.
individuals who have stopped drinking after experiencing
alcohol-related problems choose to attend AA meetings for
information and support, even though they have not been diagnosed as
NIAAA's support, scientists at medical centers and universities
throughout the country are studying alcoholism. The goal of this
research is to develop better ways of treating and preventing
alcohol problems. Today, NIAAA funds approximately 90 percent of all
alcoholism research in the United States. Some of the more exciting
investigations focus on the causes, consequences, treatment, and
prevention of alcoholism:
Alcoholism is a complex disease. Therefore, there are likely to be
many genes involved in increasing a person's risk for alcoholism.
Scientists are searching for these genes, and have found areas on
chromosomes where they are probably located. Powerful new techniques
may permit researchers to identify and measure the specific
contribution of each gene to the complex behaviors associated with
heavy drinking. This research will provide the basis for new
medications to treat alcohol-related problems.
- Treatment: NIAAA-supported researchers have made considerable
progress in evaluating commonly used therapies and in developing new
types of therapies to treat alcohol-related problems. One
large-scale study sponsored by NIAAA found that each of three
commonly used behavioral treatments for alcohol abuse and
alcoholism-motivation enhancement therapy, cognitive-behavioral
therapy, and 12-step facilitation therapy-significantly reduced
drinking in the year following treatment. This study also found that
approximately one-third of the study participants who were followed
up either were still abstinent or were drinking without serious
problems 3 years after the study ended. Other therapies that have
been evaluated and found effective in reducing alcohol problems
include brief intervention for alcohol abusers (individuals who are
not dependent on alcohol) and behavioral marital therapy for married
development: NIAAA has made developing medications to treat
alcoholism a high priority. We believe that a range of new
medications will be developed based on the results of genetic and
neuroscience research. In fact, neuroscience research has already
led to studies of one medication-naltrexone (ReVia™)-as
an anticraving medication. NIAAA-supported researchers found that
this drug, in combination with behavioral therapy, was effective in
treating alcoholism. Naltrexone, which targets the brain's reward
circuits, is the first medication approved to help maintain sobriety
after detoxification from alcohol since the approval of disulfiram
(Antabuse®) in 1949. The use of acamprosate, an
anticraving medication that is widely used in Europe, is based on
neuroscience research. Researchers believe that acamprosate works on
different brain circuits to ease the physical discomfort that occurs
when an alcoholic stops drinking. Acamprosate should be approved for
use in the United States in the near future, and other medications
are being studied as well.
medications/behavioral therapies: NIAAA-supported researchers
have found that available medications work best with behavioral
therapy. Thus, NIAAA has initiated a large-scale clinical trial to
determine which of the currently available medications and which
behavioral therapies work best together. Naltrexone and acamprosate
will each be tested separately with different behavioral therapies.
These medications will also be used together to determine if there
is some interaction between the two that makes the combination more
effective than the use of either one alone.
addition to these efforts, NIAAA is sponsoring promising research in
other vital areas, such as fetal alcohol syndrome, alcohol's effects
on the brain and other organs, aspects of drinkers' environments
that may contribute to alcohol abuse and alcoholism, strategies to
reduce alcohol-related problems, and new treatment techniques.
Together, these investigations will help prevent alcohol problems;
identify alcohol abuse and alcoholism at earlier stages; and make
available new, more effective treatment approaches for individuals
Prevention / Risk Factors
people wonder why some individuals can use alcohol without problems
but others cannot. One important reason has to do with genetics.
Scientists have found that having an alcoholic family member makes
it more likely that if you choose to drink you too may develop
alcoholism. Genes, however, are not the whole story. In fact,
scientists now believe that certain factors in a person's
environment influence whether a person with a genetic risk for
alcoholism ever develops the disease. A person's risk for developing
alcoholism can increase based on the person's environment, including
where and how he or she lives; family, friends, and culture; peer
pressure; and even how easy it is to get alcohol.