A tremendous amount of medical and psychological research has taken place to determine the exact nature of alcohol abuse. Few people would have difficulty diagnosing alcohol addiction in the wino passed out on the sidewalk. We know that any drinking by a pregnant woman is alcohol abuse due to its propensity to cause fetal alcohol syndrome. It additionally is associated with birth defects, and childhood mental problems. But what about the other end of the spectrum: Where does the defined line for the problem begin?
The first character of alcohol abuse is maladaptive behavior. Is one using alcohol to cope with stress, social ill-ease, depression, grief, social isolation, or other human situations which require more constructive solutions? What are the repercussions? Is the alcohol use contributing to the failure of the drinker to meet obligations? Has it caused run-ins with the law? Has alcohol use placed one in risky situations like drinking and driving? Does the drinker continue to use alcohol in spite of interpersonal or social problems? A positive response in any of these areas suggests alcohol abuse.
When does alcohol addiction or dependence occurs? One of the first signs is tolerance: it takes more and more alcohol to achieve the desired effect. Of people who are alcohol addicted, over 50% will have withdrawal symptoms when absence is attempted. Withdrawal can be in the form of extreme anxiety, depression, panic, hallucinations, and even seizures. The alcohol addict will use more alcohol than he intended, and will have difficulty controlling the quantities consumed. Quite often, he or she sets large quantities of time which he or she devotes to the consumption of alcohol. Their work or school performance may begin to slip through neglect. Often they will continue to use alcohol in spite of medical conditions which absolutely contraindicate its use.
How prevalent is the problem? Well, the average American male has a one in five chance of developing alcohol addiction. One in four will seek treatment on his own initiative. Alcohol use is exaggerated in the 18 to 20 year old groups. Abuse and addiction can develop by the mid twenties. The risk of alcohol dependence falls off some 90% at thirty, and to even less at age forty, although 10% of alcohol addicts develop the problem after age 40.
The National Institute of Alcohol Abuse and Addiction has gathered a lot of data, and along with other experts, has set up criteria for alcohol abuse and addiction. In healthy males up to 65 years old, the limits are no more than four drinks a day or fourteen a week. For women and men over 65, the limits are three drinks per day or seven per week. A drink is defined as ten to fourteen grams of absolute ethanol which is contained in a 0.6 ounce shot glass, a glass of wine or a beer.
What are the health repercussions of alcohol abuse and dependency? It has been shown that the risk of early death is increased three to four times by continued alcohol abuse. These deaths are most commonly due to stroke, cancer, heart disease, liver cirrhosis, and high risks of accidents and suicide. About 80% of alcohol dependents smoke heavily with all those inherent health risks. Continuing heavy use is associated with depression, psychosis, insomnia, and severe anxiety. A lot of the psychiatric symptoms will abate with as little as two to four weeks of absence. Even CT scan visualized abnormalities of the brain can revert to normal with periods of absence.
One problem with alcohol addiction is its tendency to consistently relapse. Your physician can prescribe certain medications such as naltrexone which diminish alcohol craving and relapse. Disulfiram works through negative feedback: anyone drinking while taking it will develop acute, extremely uncomfortable, illness-like symptoms. Medication can carefully and temporarily be prescribed for anxiety and depression.
One needs to realize that the tension to become alcohol-addicted is inherited in up to forty to sixty per cent of cases. If your family tree is loaded with alcoholics, you would be wise to avoid experiment with alcohol.
Your doctor should ask you straightforward questions about your alcohol use in the same manner he asks about diet, exercise and smoking. Hopefully he can encourage your candor by doing so in a non-judgmental fashion. If he determinates that there is an abuse or dependency problem present, hopefully you will work with him to maximize your health and avoid future preventable illness. Even though it may be hard to imagine, the ultimate goal should be to obtain lasting abstinence. Abstinence is not a cure for this life-long problem: it is remission in the same way as cancer remission. But it will allow your health and personal life to return to the more fulfilling and productive ones present before the sunset of this unfortunate condition.
John Drew Laurusonis, MD
Doctors Medical Center