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Alcohol Answers FAQ

  1. Return to Education HomeChildren
    Is alcohol dependence (alcoholism) a disease?
  2. What is the difference between alcohol dependence (alcoholism) and alcohol abuse?
  3. Is alcohol dependence (alcoholism) inherited?
  4. Can alcohol dependence (alcoholism) be treated or cured?
  5. What role do medications for alcohol dependence play?
  6. What exactly is alcohol?
  7. How does alcohol affect a person?
  8. I'm young, is drinking bad for my health?
  9. Why do some people react differently to alcohol than others?
  10. What is a standard drink in the United States?
  11. How much is "too much"?
  12. How do I know if I or someone else has a drinking problem?
  13. What can I do if I, or someone I know, have a drinking problem?
  14. What if the alcohol dependent person is unwilling to get help?
  15. What is alcohol withdrawal like, and how is it treated?
  16. Which medications are available to treat alcohol dependence?

1. Is alcohol dependence (alcoholism) a disease?

Yes, alcohol dependence (alcoholism) is a disease. Alcohol dependence alters parts of the brain from its normal healthy state, this is called disease.1 There now exists undisputable evidence provided by brain imagery scans that show differences in the brains of people dependent on alcohol vs. people who are not.1

Any ongoing debate about whether or not alcoholism is a disease results from a misunderstanding of the definition of both alcoholism and disease.2  (See Glossary.)

The craving that an alcohol-dependent person feels for alcohol can be as strong as the need for food or water. An alcohol-dependent person will continue to drink despite serious family, health, or legal problems.3

Like many other diseases, alcohol dependence (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 alcohol dependence (alcoholism) is influenced both by a person's genes and by his or her lifestyle.3

For more information See: Alcohol Alert No. 30: Diagnostic Criteria for Alcohol Abuse and Dependence.

References

  1. Nora Volkow, MD, Director, National Institute on Drug Abuse (NIDA), 2007
  2. William L. White, A Disease Concept for the 21st Century, April 2001
  3. The National Institute on Alcohol Abuse and Alcoholism (NIAAA), February, 2007

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2. What is the difference between alcohol dependence (alcoholism) and alcohol abuse?

Alcoholism, alcohol dependence, alcohol addiction are synonymous. It is a diagnosable disease characterized by several factors including a strong craving for alcohol, continued use despite harm or personal injury, the inability to limit drinking, physical illness when drinking stops, and the need to increase the amount drunk in order to feel the effects.1

Alcohol abuse is a pattern of drinking that results in harm to one's health, interpersonal relationships or ability to work. Certain manifestations of alcohol abuse include failure to fulfill responsibilities at work, school or home; drinking in dangerous situations such as while driving; legal problems associated with alcohol use and continued drinking despite problems that are caused or worsened by drinking. Alcohol abuse can lead to alcohol dependence.1

For more information see: Alcohol: Abuse, Dependence

References

  1. Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV), published by the American Psychiatric Association, Washington D.C., 1994.

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3. Is alcohol dependence (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. Friends, the amount of stress in life, and how readily available alcohol is also are factors that may increase risk for alcoholism.1

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 if someone is at risk is important, though, because then steps can be taken to protect one from developing problems with alcohol.1

For more information See: Alcohol Alert No. 18: The Genetics of Alcoholism and A Family History of Alcoholism - Are You at Risk?

References

  1. The National Institute on Alcohol Abuse and Alcoholism (NIAAA), February, 2007

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4. Can alcohol dependence (alcoholism) be treated or cured?

Alcohol dependence (alcoholism) can be treated. Alcohol dependence treatment programs use both counseling and medications to help a person stop drinking. Treatment has helped many people stop drinking and rebuild their lives.1

Alcohol dependence 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 abstinent. Others have long periods of abstinence 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 less likely he or she will be to have related health problems.1

Alcohol dependence (alcoholism) cannot be cured at this time. Even if an alcohol dependent patient 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 alcohol dependence (alcoholism).1 

For more information See: Alcohol Alert No. 49: New Advances in Alcoholism Treatment.

References

  1. The National Institute on Alcohol Abuse and Alcoholism (NIAAA), February, 2007

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5. What role do medications for alcohol dependence play?

There are now medications currently approved for treating alcohol dependence. They have been shown to help patients reduce drinking, avoid relapse to heavy drinking, achieve and maintain abstinence, or gain a combination of these effects. As is true in treating any chronic illness, addressing patient adherence issues throughout the treatment will maximize the effectiveness of these medications.1

All of the currently approved medications have been shown to be effective adjuncts to the treatment of alcohol dependence. Thus, consider medications when you and your healthcare provider are evaluating which treatments are appropriate for you. Patients who have previously failed to respond to psychosocial approaches alone are particularly strong candidates.1

Which medication to use will depend on clinical judgment and patient preference. Each has a different mechanism of action. Some patients may respond better to one type of medication than another.1

Medication alone is not considered a reasonable treatment plan. Almost all studies of medications for alcohol dependence have included some type of counseling, and it's recommended that all patients taking these medications receive at least brief medical counseling.1
See chart of the four medications currently approved for the treatment of alcohol dependence.

References

  1. Helping patients who drink too much A clinician's guide, 2005 edition US Dept. of Health & Human Services, National Institute oh Health, NIAAA http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf

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6. What exactly is alcohol?

Alcohol is a chemical, a substance, a drug, because it is legal and socially accepted in our society and has a long history it is viewed differently than other drugs or chemicals. Ethyl alcohol, or ethanol, is an intoxicating ingredient found in beer, wine, and liquor.1 All alcoholic drinks contain ethanol, it is produced by the fermentation of yeast, sugars, and starches.  (C6H12O6 (Glucose) + H2O==(Yeast)==> C2H6OH (ethyl alcohol) + CO2) Ethyl Alcohol  C2H6O (EtOH) boils at 172 degrees F and freezes at -173 degrees F, this colorless liquid is flammable in air when there is 3-19% ethanol in the vapor.

"Proof number" is a measurement of the alcohol content in a beverage. This measurement originated during the 18th century, when payments to sailors included rations of brandy. To ensure that the brandy being used as payment has not been watered down or was of good quality, it was proved by dousing gunpowder in a sample of brandy, and testing to see if it would ignite. If it didn't ignite, the solution had too much water in it and the proof was considered low or "underproof". If it did ignite that was considered "proof" of sufficient alcohol content. Proof number is twice the percentage of the alcohol content measured by volume at a temperature of 60°F. Therefore, "80 proof" is 40% alcohol by volume (most of the other 60% is water), and pure alcohol would be "200 proof".

References

  1. Department of Health and Human Services, Centers for Disease Control and Prevention, Alcohol and Public Health, http://www.cdc.gov/

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7. How does alcohol affect a person?

Alcohol affects every organ in the body. It is a central nervous system depressant that is rapidly absorbed from the stomach and small intestine into the bloodstream. Alcohol is metabolized in the liver by enzymes, however, the liver can only metabolize a small amount of alcohol at a time, leaving the excess alcohol to circulate throughout the body. The intensity of the effect of alcohol on the body is directly related to the amount consumed. It is the amount of ethanol consumed that affects a person most, not the type of alcoholic drink.1

For more information see: Alcohol Alert #63, Alcohol's damaging effects on the brain, 2004 and Health Risks and Benefits of Alcohol Consumption (NIAAA)

References

  1. Department of Health and Human Services, Centers for Disease Control and Prevention, Alcohol and Public Health, http://www.cdc.gov/

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8. I'm young, is drinking bad for my health?

Yes, studies have shown that alcohol use by youth and young adults increases the risk of both fatal and nonfatal injuries.1,2,3 Research has also shown that youth who use alcohol before age 15 are four times more likely to become alcohol dependent than adults who begin drinking at age 21.4 Other consequences of youth alcohol use include increased risky sexual behaviors, poor school performance, and increased risk of suicide and homicide.5,6

For more information see: Alcohol Alert #67 Underage Drinking, January 2006, NIAAA and Alcohol Alert #59, Underage Drinking: A Major Public Health Challenge, 2003, NIAAA

References

  1. Hingson RW, Heeren T, Jamanka A, Howland J. Age of onset and unintentional injury involvement after drinking. JAMA 2000; 284(12): 1527–1533.
  2. Hingson RW, Heeren T, Winter M, Wechsler H. Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18–24: Changes from 1998 to 2001. Annu Rev Public Health, 2005; 26:259–79.
  3. Levy DT, Mallonee S, Miller TR, Smith GS, Spicer RS, Romano EO, Fisher DA. Alcohol involvement in burn, submersion, spinal cord, and brain injuries. Medical Science Monitor 2004; 10(1):CR17–24.
  4. Grant GF and Dawson DA. Age at onset of alcohol use and its association with DSM-IV Alcohol Abuse and Dependence. Journal of Substance Abuse, 1997;(9):103–110.
  5. Grunbaum JA, Kann L, Kinchen S, Ross J, Hawkins J, Lowry R, et al. Youth Risk Behavior Surveillance–United States, 2003. MMWR, 53(No. SS-2):1–96.
  6. Centers for Disease Control and Prevention. Alcohol-Related Disease Impact (ARDI) software. Released September 2004. Accessed February 28, 2006.

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9. Why do some people react differently to alcohol than others?

Individual reactions to alcohol vary, and are influenced by many factors, including but not limited to:1

  • Age.
  • Gender.
  • Race or ethnicity.
  • Physical condition (weight, fitness level, etc).
  • Amount of food consumed before drinking.
  • How quickly the alcohol was consumed.
  • Use of drugs or prescription medicines.
  • Family history of alcohol problems.

References

  1. Department of Health and Human Services, Centers for Disease Control and Prevention, Alcohol and Public Health, http://www.cdc.gov/

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10. What is a standard drink in the United States?

A standard drink is equal to 13.7 grams of pure alcohol or

  • 12-ounces of beer.
  • 8-ounces of malt liquor.
  • 5-ounces of wine.
  • 1.5-ounces or a "shot" of 80-proof distilled spirits or liquor (gin, rum, vodka, whiskey, etc).

Photo illustrating sizes of standard drinks: beer (12 ounces), malt liquor (8-9 ounces), table wine (5 ounces), liqueur (2-9 ounces), brandy (1.5 ounces), spirits (1.5 ounces). See page 24 of the Clinician's Guide.
Courtesy of NIAAA, NIH Publication No. 07–3769, May 2007

References

  1. Department of Health and Human Services, Centers for Disease Control and Prevention, Alcohol and Public Health, http://www.cdc.gov/

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11. How much is "too much"?

Drinking becomes too much when it causes or elevates the risk for alcohol-related problems or complicates the management of other health problems. According to epidemiologic research, men who drink more than 4 standard drinks in a day (or more than 14 per week) and women who drink more than 3 in a day (or more than 7 per week) are at increased risk for alcohol-related problems.1

Individual responses to alcohol vary, however. Drinking at lower levels may be problematic depending on many factors, such as age, coexisting conditions, and use of medication. Because it isn't known whether any amount of alcohol is safe during pregnancy, the Surgeon General urges abstinence for women who are or may become pregnant.2

References

  1. Dawson DA, Grant BF, Li TK. Quantifying the risks associated with exceeding recommended drinking limits. Alcohol Clin Exp Res. 29(5):902-908, 2005.
  2. U.S. Surgeon General releases advisory on alcohol use in pregnancy [press release]. Washington, DC. U.S. Department of Health and Human Services. February 21, 2005. Available at: http://www.surgeongeneral.gov/pressreleases/sg02222005.html. Accessed October 3, 2006.

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12. How do I know if I or someone else has a drinking problem?

If you suspect you have a drinking problem you probably do. Drinking is a problem if it causes trouble in your relationships, in school, in social activities, or in how you think and feel. If you are concerned that either you or someone in your family might have a drinking problem, consult your personal physician.1

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.2

References

  1. Department of Health and Human Services, Centers for Disease Control and Prevention, Alcohol and Public Health, http://www.cdc.gov/
  2. The National Institute on Alcohol Abuse and Alcoholism (NIAAA), February, 2007

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13. What can I do if I, or someone I know, have a drinking problem?

Consult your personal physician if you feel you or someone you know has a drinking problem. Other resources include the National Drug and Alcohol Treatment Referral Routing Service available at 1-800-662-HELP. This service can provide you with information about treatment programs in your local community and allow you to speak with someone about alcohol problems.1

A Quick Guide to Finding Effective Alcohol and Drug Addiction Treatment.2

If you or someone you care for is dependent on alcohol or drugs and needs treatment, it is important to know that no single treatment approach is appropriate for all individuals. Finding the right treatment program involves careful consideration of such things as the setting, length of care, philosophical approach and your or your loved one's needs.

The U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration maintains a treatment facility locator available 24/7 at: http://dasis3.samhsa.gov/

Here are 12 questions to consider when selecting a treatment program:

  1. Does the program accept your insurance? If not, will they work with you on a payment plan or find other means of support for you?
  2. Is the program run by state-accredited, licensed and/or trained professionals?
  3. Is the facility clean, organized and well run?
  4. Does the program encompass the full range of needs of the individual (medical: including infectious diseases; psychological: including co-occurring mental illness; social; vocational; legal; etc.)?
  5. Does the treatment program also address sexual orientation and physical disabilities as well as provide age, gender and culturally appropriate treatment services?
  6. Is long-term aftercare support and/or guidance encouraged, provided and maintained?
  7. Is there ongoing assessment of an individual's treatment plan to ensure it meets changing needs?
  8. Does the program employ strategies to engage and keep individuals in longer-term treatment, increasing the likelihood of success?
  9. Does the program offer counseling (individual or group) and other behavioral therapies to enhance the individual's ability to function in the family/community?
  10. Does the program offer medication as part of the treatment regimen, if appropriate?
  11. Is there ongoing monitoring of possible relapse to help guide patients back to abstinence?
  12. Are services or referrals offered to family members to ensure they understand addiction and the recovery process to help them support the recovering individual?

References

  1. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (CSAT). www.samhsa.gov. 2007
  2. DHHS Publication No. (SMA) 02-3616 NCADI Publication No. PHD877

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14. What if the alcohol dependent person is unwilling to get help?

This can be a challenge. An alcohol dependent person 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 alcohol dependence treatment specialists suggest the following steps to help someone in need get treatment:

  • Stop all "cover ups." Family members often make excuses to others or try to protect the alcohol dependent person from the results of his or her drinking. It is important to stop covering for the alcohol dependent person 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 alcohol dependent person 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 alcohol dependent person 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 alcohol-dependent people. These groups help family members understand that they are not responsible for the alcohol dependent person's drinking and that they need to take steps to take care of themselves, regardless of whether the alcohol-dependent  family member chooses to get help.

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.1

References

  1. The National Institute on Alcohol Abuse and Alcoholism (NIAAA), February, 2007 http://www.niaaa.nih.gov/

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15. What is alcohol withdrawal like, and how is it treated?

Alcohol withdrawal results when a person who is alcohol dependent suddenly stops drinking. Symptoms usually start within a few hours and consist of tremors, sweating, elevated pulse and blood pressure, nausea, insomnia, and anxiety. Generalized seizures may also occur. A second syndrome, alcohol withdrawal delirium, sometimes follows. Beginning after 1 to 3 days and lasting 2 to 10 days, it consists of an altered sensorium, disorientation, poor short-term memory, altered sleep-wake cycle, and hallucinations. Management typically consists of administering thiamine and benzodiazepines, sometimes together with anticonvulsants, beta adrenergic blockers, or antipsychotics as indicated. Mild withdrawal can be managed successfully in the outpatient setting, but more complicated or severe cases require hospitalization.1

References

  1. Helping patients who drink too much A clinician's guide, 2005 edition US Dept. of Health & Human Services, National Institute oh Health, NIAAA http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf

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16. Which medications are available to treat alcohol dependence?

Three oral medications are currently approved to treat alcohol dependence:

  • disulfiram (Antabuse®)
  • naltrexone (Depade®, ReVia®)
  • acamprosate (Campral®)

In addition, an injectable, long-acting (30 day) form of naltrexone (VIVITROL®) became available in 2006.1
These medications have been shown to help people with alcohol dependence reduce their drinking, avoid relapse to heavy drinking, and achieve and maintain abstinence.1

Naltrexone acts in the brain to reduce craving for alcohol after someone has stopped drinking.1

Acamprosate is thought to work by reducing symptoms that follow lengthy abstinence, such as anxiety and insomnia.1

Disulfiram discourages drinking by making the person taking it feel sick after drinking alcohol.1

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.1

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.1

For more information see: Naltrexone for Extended-Release Injectable Suspension for Treatment of Alcohol Dependence, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration. (2007, vol.6, issue1)

(See also "News Releases," Jan. 17, 1995: Naltrexone Approved for Alcoholism Treatment and "Publication," Alcohol Alert No. 61: Neuroscience Research and Therapeutic Targets.)


References

  1. The National Institute on Alcohol Abuse and Alcoholism (NIAAA), February, 2007

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